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External quality assessment for warfarin dosing using computerised decision support software.

T P Oppenkowski, E T Murray, H Sandhar

    Journal of Clinical Pathology
    |August 2, 2003
    PubMed
    Summary
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    This study established an external quality assessment scheme for warfarin dosing using the BAP-PC system. The scheme demonstrated good therapeutic international normalised ratio control, though data quality requires further evaluation.

    Area of Science:

    • Pharmacology
    • Clinical Pharmacy
    • Health Informatics

    Background:

    • Warfarin dosing requires careful management to maintain therapeutic international normalised ratio (INR) levels.
    • Computerised decision support systems (CDSS) like BAP-PC aim to improve warfarin management in primary care.
    • External quality assessment (EQA) schemes are crucial for monitoring and improving clinical practice.

    Purpose of the Study:

    • To establish and evaluate an external quality assessment (EQA) scheme for warfarin dosing.
    • To assess the performance of the BAP-PC computerised decision support system in primary care settings.
    • To benchmark warfarin dosing practices across multiple primary care centres.

    Main Methods:

    • Analysis of 12 months of clinical data from 10 primary care centres utilizing the BAP-PC system.

    Related Experiment Videos

  • Evaluation of warfarin dosing performance based on time in therapeutic range (TTR) and international normalised ratio (INR) control.
  • Comparison of individual centre data with aggregated data and provision of feedback forms.

    • Main Results:

    • A total of 367 patients were analyzed, with an average time in therapeutic range (TTR) of 69%.
    • The average point prevalence of patients managed was 86%, with patients seen approximately every 27 days.
    • A serious adverse event rate of 1.6 per 100 patient-years was observed, with 33 total adverse events reported across practices.

    Conclusions:

    • Participating primary care centres demonstrated successful therapeutic INR control, achieving 60% or higher time in range.
    • Concerns regarding data collection quality were noted due to a lack of reported events in some centres.
    • Further EQA scheme cycles are recommended to establish its utility as a research and benchmarking tool for warfarin management.