186 Anticoagulation Stewardship Using a Direct Oral Anticoagulation Dashboard to Reduce Incorrect Prescribing
Recommended Citation
Lee J, Ellsworth S, Haymart B, Krol G, Stallings B, Ryan N, Lanham M, Barnes G, Kaatz S. 186 Anticoagulation Stewardship Using a Direct Oral Anticoagulation Dashboard to Reduce Incorrect Prescribing. Res Pract Thromb Haemost 2025; 9.
Document Type
Conference Proceeding
Publication Date
5-1-2025
Publication Title
Res Pract Thromb Haemost
Abstract
Background: Direct oral anticoagulants (DOACs) are guideline preferred treatment in nonvalvular atrial fibrillation and venous thromboembolism, they have complex dosing regimens leading to frequent inaccurate dosing and increased risks of bleeding and thromboembolism. Population health dashboards are an effective tool for antithrombotic stewardship to identify and correct inaccurate DOAC dosing and reduce harms. While these dashboards have been shown to reduce inaccurate DOAC dosing and clinical harms in the Veterans Health Affairs (VHA) system, data is lacking in non-VHA health systems. Objectives: Compared the effectiveness of a DOAC dashboard in reducing incorrect dosing, drug interactions and use of another anticoagulant between patients managed vs. not managed by the DOAC Dashboard within a large health system. Methods: Henry Ford Health implemented an Epic-based DOAC Dashboard developed by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2). The dashboard categorizes alerts into critical, possible critical and FYI. This analysis focused on “critical alerts” which include incorrect DOAC dosing, drug interactions and multiple prescribed anticoagulants. The anticoagulation stewardship service utilized the DOAC Dashboard to monitor and intervene on DOAC-treated patients in one large, unified medical group but not patients managed by clinicians outside that medical group but within the larger Henry Ford Health system. The proportion of patients with “critical alerts” was compared at the end of the analytic timeframe with chi square and Poisson tests. Results: 468 of 6930 (6.8%) patients in the intervention group and 1063 of 14337 (7.4%) patients outside the intervention group had critical alerts at the start of the analysis. These rates remained steady for 4 months prior to dashboard implementation. Within 4 months following implementation, the rates of critical alerts dropped to 2% and 8%, respectfully, and remained consistent for 18 months. At the end, 222 of 9819 (2.3%) and 1887 of 21453 (8.8%) patients for the intervention and control populations, respectively, had critical alerts [p < 0.0001; ratio 0.26, 95% CI (0.22-0.30)]. Conclusion: Anticoagulation stewardship using a DOAC dashboard significantly reduced critical incorrect prescribing.
Volume
9
