Abstract
BackgroundUse of direct oral anticoagulants (DOAC) is rapidly growing for treatment of atrial fibrillation and venous thromboembolism. However, incorrect dosing of these medications is common and puts patients at risk of adverse drug events. One way to improve safe prescribing is the use of population health tools, including interactive dashboards built into the electronic health record (EHR). As such tools become more common, exploring ways to understand which aspects are effective in specific settings and how to effectively adapt and implement in existing anticoagulation clinics across different health systems is vital.MethodsThis three-phase project will evaluate a current nation-wide implementation effort of the DOAC Dashboard in the Veterans Health Administration (VHA) using both quantitative and qualitative methods. Informed by this evaluation, the DOAC Dashboard will be implemented in four new health systems using an implementation strategy derived from the VHA experience and interviews with providers in those new health systems. Quantitative evaluation of the VHA and non-VHA implementation will follow the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Qualitative interviews with stakeholders will be analyzed using the Consolidated Framework for Implementation Research and Technology Acceptance Models to identify key determinants of implementation success.DiscussionThis study will (1) evaluate the implementation of an EHR-based population health tool for medication management within a large, nation-wide, highly integrated health system; (2) guide the adoption in a set of four different health systems; and (3) evaluation that multi-center implementation effort. These findings will help to inform future EHR-based implementation efforts in a wide variety of health care settings.
Highlights
Use of direct oral anticoagulants (DOAC) is rapidly growing for treatment of atrial fibrillation and venous thromboembolism
This study will evaluate the implementation of a multi-center electronic health record-based population health tool for anticoagulant medication management
This study will help explore the impact of population health tools for safe anticoagulant medication management in a variety of different clinical contexts
Summary
1) Evaluate the effectiveness, implementation successes, and limitations of the DOAC Dashboard for safe DOAC prescribing within the national VHA system. Reach will be calculated as the number (and percent) of patients taking DOAC medications who are managed at sites with regular (at least weekly) DOAC Dashboard use We will assess realized determinants of implementation success in the national VHA health system This will be done by conducting semi-structured interviews with key DOAC Dashboard stakeholders (primarily pharmacists, and physicians, nurses, managers) at different VHA centers within each use category (low/no, moderate, high). We will assess anticipated determinants of implementation success at four non-VHA health centers participating in the MAQI2 consortium These semistructured interviews will include the same stakeholders as in the VHA interviews. We have enthusiastic support from each of the health systems’ anticoagulation clinic leadership and a commitment to providing staff resources to implement and use the DOAC Dashboard for all patients within their health system
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