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Evaluation of a decision support system for initiation and control of oral anticoagulation in a randomised trial
B Vadher1, D L Patterson, M Leaning
1Cardiovascular Department, Whittington Hospital, London.
Objective:
To determine whether a computerised decision support system for initiation and control of oral anticoagulant treatment improves quality of anticoagulant control achieved by trainee doctors.
Design:
Randomised controlled trial.
Setting:
District general hospital in North London.
Subjects:
148 inpatients requiring start of warfarin treatment.
Interventions:
Management by trainee doctors (to achieve therapeutic range of international normalised ratio of 2 to 3) with indirect assistance from computerised decision support system (intervention group) or without such assistance (control group).
Main Outcome Measures:
Median time to therapeutic range, stable dose, and first pseudoevent (excessive international normalised ratio after therapeutic range has been reached) and person time spent in the therapeutic range.
Results:
72 patients were randomised to the intervention group and 76 to control group. Median time to reach international normalised ratio of > or = 2 was not significantly different in the two groups (3 days). Median time to achieve a stable dose was significantly lower in intervention group than in controls (7 days v 9 days, P = 0.01) without excessive overtreatment or undertreatment with anticoagulant. Patients in intervention group spent greater proportion of time in therapeutic range, both as inpatients (59% v 52%) and outpatients (64% v 51%).
Conclusion:
The computerised decision support system was safe and effective and improved the quality of initiation and control of warfarin treatment by trainee doctors.