Priorities, Approaches, and Performance for Outpatient Antithrombotic Stewardship: The ADAPT Project

Area of Science:

• Pharmacology
• Health Services Research
• Quality Improvement

Background:

• Antithrombotic (AT) agents are essential but linked to preventable adverse events.
• Outpatient AT stewardship lacks standardized measurement infrastructure compared to antimicrobial stewardship.
• Characterizing outpatient practices and identifying gaps in monitoring and tracking is needed for quality improvement.

Purpose of the Study:

• To characterize current outpatient antithrombotic stewardship practices across five care process priorities (CPPs).
• To examine the gaps between clinical monitoring and system-level tracking in outpatient settings.
• To inform future quality measurement and benchmarking initiatives in AT stewardship.

Main Methods:

• A sequential explanatory mixed methods evaluation was conducted.
• A national cross-sectional survey assessed clinical monitoring and system-level tracking for CPPs.
• Semistructured interviews explored operational aspects, facilitators, and barriers.

Main Results:

• Monitoring of CPPs was common, but system-level tracking was less prevalent and varied by CPP and setting.
• Protocols were often in place, but routine adherence tracking was rare.
• US Department of Veterans Affairs (VA) sites showed higher systemwide tracking, particularly for warfarin time in therapeutic range (TTR), compared to non-VA sites.

Conclusions:

• Outpatient AT stewardship exhibits high variability and a significant gap between monitoring and population-level tracking.
• Transitioning from monitoring to tracking is essential for developing quality measures and benchmarking.
• Priorities for advancement include governance, data automation, and operational support for scalable measurement.