Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Researchers measure quality of care in oral anticoagulation

04.01.2011
Researchers from Boston University School of Medicine (BUSM) and the Bedford VA Medical Center believe that risk-adjusted percent time in therapeutic range (TTR) should be used as part of an effort to improve anticoagulation control and thus improve patient outcomes. These findings appear in this month's issue of Circulation: Cardiovascular Quality and Outcomes.

Oral anticoagulation with warfarin is received by millions of Americans each year to treat blood clots and to prevent strokes. While warfarin is effective, it is difficult to thin a patient's blood enough to protect them while avoiding dangerous over-anticoagulation. Excessive anticoagulation may result in serious or even fatal bleeding, particularly bleeding around the brain. Inadequate anticoagulation leaves the patient vulnerable to the events (such as stroke) that warfarin is used to prevent.

Previous studies have shown that better anticoagulation control can prevent many of these adverse events. "We have known for many years that anticoagulation control needs improvement, however, there has been no concerted effort to profile sites of care on anticoagulation control, as measured by percent time in therapeutic range," said lead author Adam Rose, MD, MSc, an assistant professor of medicine at BUSM and investigator at the Bedford VA Medical Center.

In addition, performance profiling can be complex, because some sites treat more challenging patient populations than others. Without adjusting for such complexity, they cannot know whether differences in site-level performance are due to the quality of care or the patient population. A model that adjusts for complexity is commonly called a "risk-adjustment model," and results that have been adjusted in this way are called "risk-adjusted results."

The researchers profiled 100 sites of care within the Veterans Health Administration using risk-adjusted TTR. According to them, the main findings of the study are threefold. First, TTR varied widely among VA anticoagulation clinics, from 38 percent time in range to 69 percent, or from poor to excellent control. This suggests that some VA sites are already doing very well with this area of care, while others need to improve. Second, while risk-adjustment did not alter performance rankings for many sites, for other sites it made an important difference. For example, the anticoagulation clinic that was ranked 27th out of 100 before risk adjustment was ranked as one of the best (7th) after risk-adjustment. This demonstrates the importance of adjusting TTR for case mix when profiling performance. Third, site performance on risk-adjusted TTR was consistent from year to year, suggesting that risk-adjusted TTR measures a construct (quality of care) that is stable over time, rather than mere statistical variation.

"Our study suggests that risk-adjusted TTR should be considered for more widespread use as a performance measure as part of an effort to improve anticoagulation control and thus improve patient outcomes, said Rose. "In the past, the VA has led efforts to measure and improve quality in other areas of care, and numerous studies have shown that the VA delivers care that is as good as or better than non-VA care. We plan to make the VA a leader in delivering high-quality anticoagulation care as well," he added. The authors note that profiling anticoagulation performance is within the reach of any integrated health care system.

"As a nation, we spend vast amounts of effort and resources profiling performance regarding diabetes, blood pressure, acute coronary syndromes, cancer screening, and commonly performed surgeries," explained Rose. "Until now, we have not tried to profile performance regarding anticoagulation control. This study suggests that we can - and we should."

Gina DiGravio | EurekAlert!
Further information:
http://www.bmc.org

More articles from Health and Medicine:

nachricht Penn studies find promise for innovations in liquid biopsies
30.03.2017 | University of Pennsylvania School of Medicine

nachricht 'On-off switch' brings researchers a step closer to potential HIV vaccine
30.03.2017 | University of Nebraska-Lincoln

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: A Challenging European Research Project to Develop New Tiny Microscopes

The Institute of Semiconductor Technology and the Institute of Physical and Theoretical Chemistry, both members of the Laboratory for Emerging Nanometrology (LENA), at Technische Universität Braunschweig are partners in a new European research project entitled ChipScope, which aims to develop a completely new and extremely small optical microscope capable of observing the interior of living cells in real time. A consortium of 7 partners from 5 countries will tackle this issue with very ambitious objectives during a four-year research program.

To demonstrate the usefulness of this new scientific tool, at the end of the project the developed chip-sized microscope will be used to observe in real-time...

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

'On-off switch' brings researchers a step closer to potential HIV vaccine

30.03.2017 | Health and Medicine

Penn studies find promise for innovations in liquid biopsies

30.03.2017 | Health and Medicine

An LED-based device for imaging radiation induced skin damage

30.03.2017 | Medical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>