Lack of Daily Warfarin Monitoring in Hospitals Linked to Higher Risk of Adverse Events: AHRQ Study

Issue 501
AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.
January 12, 2016

AHRQ Stats: Well-Child Visits

From 2000 to 2013, the number of Hispanic children who had a well-child visit in the last 12 months increased by 14 percent. That's more than the 12 percent increase in well-child visits for both black and white children. (Source: Agency for Healthcare Research and Quality, 2014 National Healthcare Quality and Disparities Report, Chartbook for Hispanic Health Care).

Today's Headlines

  1. Lack of Daily Warfarin Monitoring in Hospitals Linked to Higher Risk of Adverse Events: AHRQ Study
  2. Journal Supplement Explores Issues Surrounding Physician Behaviors, Decision-Making and Care Delivery Models
  3. New Action Planning Tool Available for AHRQ Safety Culture Surveys
  4. AHRQ Announces Health Literacy Continuing Education Offerings
  5. New Research and Evidence From AHRQ
  6. Featured Case Study: N.C. Physicians Use AHRQ Materials To Boost Communication With Patients
  7. AHRQ in the Professional Literature

1. Lack of Daily Warfarin Monitoring in Hospitals Linked to Higher Risk of Adverse Events: AHRQ Study

Patients taking the anticoagulant warfarin while hospitalized for pneumonia, heart failure or heart attack or following major surgery are at increased risk of an adverse event if their body's ability to clot blood is not tested daily, an AHRQ-funded research team found. Warfarin is a commonly used anticoagulant and is among medications often associated with adverse drug events. Patients who have high levels of international normalized ratios (INR), a measure of the blood's ability to clot, are at higher risk for adverse events. To test the relationship between daily and less frequent INR monitoring and warfarin-associated adverse events, researchers analyzed data between 2009 and 2013 from the Medicare Patient Safety Monitoring System, a national chart abstraction system. Patients whose INR was not measured on two or more consecutive days had higher risks for warfarin-associated adverse events, particularly cardiac and surgical patients.  A one-day increase in INR of more than 0.9 predicted a greater risk for overly high levels of the anticoagulant, researchers found. An abstract and the article, "Predictors of Warfarin-Associated Adverse Events in Hospitalized Patients: Opportunities to Prevent Patient Harm," were published online in the December 14 issue of the Journal of Hospital Medicine.

2. Journal Supplement Explores Issues Surrounding Physician Behaviors, Decision-Making and Care Delivery Models

A series of AHRQ-funded articles appearing in a special supplement of the Journal of General Internal Medicine explores core issues around physician practices, including physician behaviors, decision-making and care delivery models. One study examined the three main sampling methods to count the number of physicians in a given area, and concluded that the National Provider and Plan Enumeration System appears to provide accurate, up-to-date address information for physicians billing public and provider insurers. Other articles explore the changing economics of medical practices, the linkage between primary care and patient outcomes, the use of clinical vignettes and measurement of comprehensiveness of primary care. Access the article abstracts.

3. New Action Planning Tool Available for AHRQ Safety Culture Surveys

A new Action Planning Tool for AHRQ Surveys on Patient Safety Culture is now available. After assessing patient safety culture, organizations may use the planning tool to determine steps needed for improvements. The resource provides step-by-step guidance to develop an action plan to improve patient safety culture. Organizations may find it useful, for example, to brainstorm the potential barriers to implementing initiatives, as well as strategies to overcome them. The Action Plan Template is designed to record the goals, initiatives, resources needed, process and outcome measures and timelines. For questions, email SafetyCultureSurveys@westat.com or call 1-888-324-9749.

4. AHRQ Announces Health Literacy Continuing Education Offerings

Nurses and doctors can now earn continuing education credits at no cost for completing AHRQ-supported learning modules that highlight the challenges of caring for patients with low health literacy as well as strategies for improving patient communication and care. Select to access Web-based modules developed in collaboration with OptumHealth: An Updated Overview of Health Literacy or Improving Health Literacy by Improving Communication Skills. In addition, board-certified pediatricians and family physicians can earn maintenance of certification credit through health literacy self-assessment activities through American Board of Pediatrics and American Board of Family Medicine online learning activities.

5. New Research and Data From AHRQ

6. Featured Case Study: N.C. Physicians Use AHRQ Materials To Boost Communication With Patients

G and G Healthcare P.C., a primary care practice based in Whiteville, North Carolina, uses AHRQ's Questions Are the Answer educational materials to improve communication between physicians and patients and their families. The Carolinas Center for Medical Excellence found AHRQ materials increased positive scores for patient survey questions from 31 percent to 100 percent over a 10-month period in 2013. Read the case study.

7. AHRQ in the Professional Literature

A qualitative study of vulnerable patient views of type 2 diabetes consumer reports. Longo DR, Crabtree BF, Pellerano MB, et al. Patient 2015 Nov 7. Access the abstract on PubMed®.

Connecting emergency department patients to primary care. Wexler R, Hefner JL, Sieck C, et al. J Am Board Fam Med 2015 Nov-Dec;28(6):722-32. Access the abstract on PubMed®.

Evidence synthesis activities of a hospital evidence-based practice center and impact on hospital decision making. Jayakumar KL, Lavenberg JA, Mitchell MD. J Hosp Med 2015 Oct 27. Access the abstract on PubMed®.

Provider preferences and experiences with a countywide centralized collaborative reminder/recall for childhood immunizations. Saville AW, Gurfinkel D, Sevick C, et al. Acad Pediatr 2015 Sep 26. Access the abstract on PubMed®.

Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting. Chung S, Zhao B, Lauderdale D, et al. Prim Care Diabetes 2015 Feb;9(1):23-30. Epub 2014 May 5. Access the abstract on PubMed®.

Psychosocial stress as a risk factor for sepsis: a population-based cohort study. Ojard C, Donnelly JP, Safford MM, et al. Psychosom Med 2015 Jan;77(1):93-100. Access the abstract on PubMed®.

Patient safety in plastic surgery: identifying areas for quality improvement efforts. Hernandez-Boussard T, McDonald KM, Rhoads KF, et al. Ann Plast Surg 2015 May;74(5):597-602. Access the abstract on PubMed®.

The incremental risk of coronary stents on postoperative adverse events: a matched cohort Study. Holcomb CN, Graham LA, Richman JS, et al. Ann Surg 2015 Apr 17. Access the abstract on PubMed®.

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Page last reviewed January 2016
Page originally created January 2016
Internet Citation: Lack of Daily Warfarin Monitoring in Hospitals Linked to Higher Risk of Adverse Events: AHRQ Study. Content last reviewed January 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/501.html