Analysis of quality measures before and after switching care models in MAQI2 anticoagulation clinics
Maniaci J, Alexandris-Souphis C, Gikas H, Ali M, Kaatz S, Haymart B, Gearhart N, DeYoung M, Ellsworth S, Froehlich J, Barnes G, Kline-Rogers E, and Ryan N. Analysis of quality measures before and after switching care models in MAQI2 anticoagulation clinics. J Thromb Thrombolysis 2019; 47(4):604.
J Thromb Thrombolysis
Introduction: There are various warfarin management models in the U.S. including: Physician Managed, Pharmacist Managed, Primary Nurse Model (in which patients are assigned to a specific nurse caseload), and the In-Basket Model (where patients are assigned to the next available nurse). We compared four sites in the Michigan Anticoagulation Quality Improvement Initiative (MAQI$sup$2$/sup$) that had switched from the In-Basket Model to the Primary Nurse Care Model. Methods: Using data from the MAQI$sup$2$/sup$ consortium, we compared distinct measures for warfarin patients managed by the In-Basket Model, followed by management via the Primary Nurse Care Model, each at 6 month intervals. Patients had at least 3 months of wafarin prior to the start of the measurement period. The number of days between the INR result and patient contact were counted. Warfarin dose adjustments were determined by calculating the number of dose changes per number of out-of-range INRs for which a next INR was available. Results: In the Primary Care Model, there was a decrease in time between INR results and nurse interaction with patients (1.4-2.1 v. 0.8-1.6, p = 0.001). Patients experienced fewer dose adjustments of any kind (67.0% v. 64.8%, p = 0.016), and fewer weekly dose changes (58.7% vs. 53.9%, p = 0.001) in the Primary Care Model. Conclusions: Use of the Primary Care Nurse Model for managing warfarin patients in the MAQI$sup$2$/sup$ consortium was associated with a decrease in the total number of warfarin dose changes, and a quicker response to INR results compared with patients managed by the In-Basket Model, suggesting that the Primary Care Nurse Model may be more efficient.