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Nationwide Implementation of a Population Management Dashboard for Monitoring Direct Oral Anticoagulants: Insights

Michael P Dorsch1,2,3, Charity S Chen4, Arthur L Allen5

  • 1College of Pharmacy (M.P.D.), University of Michigan, Ann Arbor.

Circulation. Cardiovascular Quality and Outcomes
|December 9, 2022
PubMed

Insights

A new dashboard improved direct oral anticoagulant prescribing in the Veterans Health Administration. The tool supported pharmacists in managing anticoagulation, showing rapid and sustained implementation across 94.7% of sites.

Area of Science:

  • Pharmacology
  • Health Informatics
  • Public Health

Background:

  • Direct oral anticoagulants (DOACs) are primary treatments for atrial fibrillation and venous thromboembolism.
  • Evidence-based prescribing of DOACs is complex due to varied dosing, renal function considerations, and drug interactions.
  • The Veterans Health Administration (VA) developed a population management dashboard to aid pharmacists in reviewing anticoagulant prescriptions.

Purpose of the Study:

  • To evaluate the nationwide implementation and adoption of a population health dashboard designed to support evidence-based prescribing of direct oral anticoagulants.
  • To assess the dashboard's reach, effectiveness, adoption, implementation, and maintenance within the Veterans Health Administration system.

Main Methods:

  • The study utilized login data from the population management dashboard to assess its implementation.
  • The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided the evaluation.
  • Data were collected between August 2016 and June 2020, covering 150 out of 164 VA sites.

Main Results:

  • The dashboard was adopted by 150/164 (91.5%) VA sites, with 142/150 (94.7%) achieving moderate to high adoption by June 2020.
  • Average unique users per site increased from 2.4 to 7.5 during the study period.
  • Sustained adoption (> 6 months) was achieved in 126/150 (84.0%) of sites.

Conclusions:

  • The population health dashboard was rapidly and successfully implemented and adopted nationwide within the VA system.
  • The tool effectively supported evidence-based anticoagulant prescribing.
  • Further research is needed to determine the clinical impact and to develop strategies for replicating this model in other healthcare systems.
Abstract

Keywords:
anticoagulantsatrial fibrillationclinical decision support systemsmedication errorpopulation health

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