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Published on: February 28, 2012
Assessing Anticoagulation Management and Shared Decision-Making Documentation From Providers Participating in the
Laboni Hoque1, Azraa Amroze, Vinit Gilvaz
1Ms. Hoque: University of Massachusetts Medical School, Worcester, MA. Ms. Amroze: University of Massachusetts Medical School, Worcester, MA and Meyers Primary Care Institute, Worcester, MA. Dr. Gilvaz: Department of Internal Medicine, St. Vincent Hospital, Worcester, MA. Dr. Abraham: Department of Internal Medicine, St. Vincent Hospital, Worcester, MA. Dr. Lal: Department of Medicine, Mayo Clinic, Rochester, MN. Dr. Mishra: Department of Internal Medicine, St. Vincent Hospital, Worcester, MA. Dr. Crawford: Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, and Meyers Primary Care Institute, Worcester, MA. Dr. Mazor: Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, and Meyers Primary Care Institute, Worcester, MA. Dr. McManus: Division of Cardiology, University of Massachusetts Medical School, Worcester, MA, Meyers Primary Care Institute, Worcester, MA, and University of Massachusetts Memorial Health Care, Worcester, MA. Dr. Kapoor: Division of Hospital Medicine, University of Massachusetts Medical School, Worcester, MA, Meyers Primary Care Institute, Worcester, MA, and University of Massachusetts Memorial Health Care, Worcester, MA.
Academic detailing (AD) did not improve documentation of anticoagulation management or shared decision-making for atrial fibrillation patients. Further interventions may need longer provider engagement or a specific focus on shared decision-making documentation.
Area of Science:
- Cardiology
- Medical Education
- Health Informatics
Background:
- Atrial fibrillation necessitates anticoagulation for stroke prevention.
- Educational outreach with modified academic detailing (AD) was previously tested to increase anticoagulation use.
- This study evaluates the impact of AD on documentation practices related to anticoagulation and shared decision-making.
Purpose of the Study:
- To compare documentation of AD educational topics and shared decision-making elements between providers receiving and not receiving AD.
- To assess the effectiveness of AD in improving the documentation of key anticoagulation management components.
Main Methods:
- Physicians reviewed themes from AD sessions and evaluated patient charts for shared decision-making evidence.
- Documentation frequencies of specific items were compared between AD and non-AD provider groups.
- Baseline documentation practices of AD providers were assessed through pre-intervention chart reviews.
Main Results:
- Providers infrequently documented crucial items like anticoagulation mention (44%), multiple options (5%), CHA2DS2-VASc score (11%), and bleeding risks (2%).
- AD providers showed statistically significant higher documentation for anticoagulation mention (64% vs. 35%), stroke risk (11% vs. 0%), benefits (8% vs. 0%), and patient involvement (17% vs. 0%) compared to non-AD providers.
- However, AD participation did not lead to improved documentation percentages for AD providers compared to their own baseline.
Conclusions:
- Physician documentation of essential anticoagulation management and shared decision-making elements remains infrequent.
- Academic detailing intervention, as implemented, did not enhance documentation in this study.
- More prolonged provider interaction or interventions specifically targeting shared decision-making documentation may be necessary for improved adoption.
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