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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 3 of 3 Research Studies DisplayedDorsch MP, Chen CS, Allen AL
Nationwide implementation of a population management dashboard for monitoring direct oral anticoagulants: Insights from the Veterans Affairs health system.
Although they exhibit a robust efficacy and safety profile, prescribing Direct oral anticoagulants (DOACs) in accordance with evidence-based practices can be difficult due to varying dosage requirements based on factors like indication, renal function, and drug interactions. To assist pharmacists in reviewing anticoagulant prescriptions, the Veterans Health Affairs (VHA) created and deployed a population management dashboard that displays information on DOACs, prescribed dosages, renal function, age, weight, potential drug interactions, and refill needs. This dashboard operates as a standalone system. The purpose of this study was to assess the DOAC dashboard using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, analyzing login data from the dashboard. The study found that from August 2016 to June 2020, 150 out of 164 VHA sites utilized the dashboard, with an average of 1875 patients per site. The dashboard was introduced to sites in a staggered manner. Moderate or high adoption, defined as logging in on at least two separate days per month, started slowly with 3 out of 5 pilot sites but quickly rose to 142 out of 150 (94.7%) sites by June 2020. The mean number of unique users per site grew from 2.4 to 7.5 during the study. By the end of the research period, 126 out of 150 (84.0%) sites maintained moderate to high adoption of the dashboard for over six months. The researchers concluded that the population health dashboard for evidence-based anticoagulant prescribing witnessed rapid and sustained implementation and adoption across the national VHA health system in the United States. Investigating the tool's impact on clinical outcomes and replicating this care model in other healthcare systems would be crucial for widespread dissemination and adoption.
AHRQ-funded; HS026874.
Citation: Dorsch MP, Chen CS, Allen AL .
Nationwide implementation of a population management dashboard for monitoring direct oral anticoagulants: Insights from the Veterans Affairs health system.
Circ Cardiovasc Qual Outcomes 2023 Feb; 16(2):e009256. doi: 10.1161/circoutcomes.122.009256..
Keywords: Blood Thinners, Medication, Implementation
Barnes GD, Sippola E, Ranusch A
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
This study examined the implementation of electronic dashboards and the key barriers that were found. Semi-structured interviews were conducted at the national Veterans Health Affairs (VA) following implementation of a population health tool, and in Michigan for the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2) dashboard tool designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians. A total of 45 stakeholders were interviewed, 32 at the VA, and 13 at MAQI(2). Five key determinants of implementation success were identified: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about IT support and prioritization within MAQI(2) prior to implementation but not VHA after implementation and also concerns about authority and autonomy.
AHRQ-funded; HS026874.
Citation: Barnes GD, Sippola E, Ranusch A .
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
Implement Sci Commun 2022 Feb 2;3(1):10. doi: 10.1186/s43058-022-00262-w..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Blood Thinners, Medication, Implementation
Barnes GD, Sippola E, Dorsch M
Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol.
This paper discusses the study protocol that is being used in the ongoing multi-cohort implementation evaluation study on applying population health approaches to improve safe use of direct oral anticoagulants (DOAC) for treatment of atrial fibrillation and venous thromboembolism. It is hoped that these approaches will help prevent incorrect dosing which is common and puts patients at risk of adverse events. Population health tools, including interactive dashboards built into the electronic health record (EHR), are being evaluated as a way to improve safe prescribing. A three-phase project is being conducted at the Veterans Health Administration (VHA) using both quantitative and qualitative methods. The DOAC Dashboard will be implemented in four new health systems. Quantitative evaluation of the implementation will follow the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Stakeholders will be interviewed as part of the qualitative evaluation using the Consolidated Framework for Implementation Research and Technology Acceptance Models. The goals of the study are to evaluate the implementation of the EHR-based population health tool, guide the adoption in four new health systems, and evaluate the multi-center implementation effort.
AHRQ-funded; HS026874.
Citation: Barnes GD, Sippola E, Dorsch M .
Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol.
Implement Sci 2020 Sep 21;15(1):83. doi: 10.1186/s13012-020-01044-5.
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Keywords: Blood Thinners, Medication, Patient Safety, Implementation, Adverse Drug Events (ADE), Adverse Events, Medical Errors