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Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin
INTRODUCTION: Studies have shown that achieving a time in therapeutic range (TTR) for warfarin of greater than 60% is associated with a lower risk of bleeding. However, many patients on hemodialysis (HD) do not achieve this target. METHODS: We audited TTR achievement at the in-center HD unit of our...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000800/ https://www.ncbi.nlm.nih.gov/pubmed/32043029 http://dx.doi.org/10.1016/j.ekir.2019.10.011 |
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author | Blum, Daniel Beaubien-Souligny, William Battistella, Marisa Tseng, Eric Harel, Ziv Nijjar, Jaspreet Nazvitch, Elena Silver, Samuel A. Wald, Ron |
author_facet | Blum, Daniel Beaubien-Souligny, William Battistella, Marisa Tseng, Eric Harel, Ziv Nijjar, Jaspreet Nazvitch, Elena Silver, Samuel A. Wald, Ron |
author_sort | Blum, Daniel |
collection | PubMed |
description | INTRODUCTION: Studies have shown that achieving a time in therapeutic range (TTR) for warfarin of greater than 60% is associated with a lower risk of bleeding. However, many patients on hemodialysis (HD) do not achieve this target. METHODS: We audited TTR achievement at the in-center HD unit of our hospital in 2017 and found that only 40% of patients had achieved a TTR >60%. We aimed to improve the percentage of HD patients achieving target TTR within 2 years. We reported each patient's individualized trend in quarterly TTR to their primary warfarin prescriber as an audit-feedback report. These reports were generated, disseminated, and subsequently improved following a series of plan-do-study-act cycles. We then used statistical process control to assess for changes in the percentage of HD patients achieving target TTR over time. RESULTS: In the primary analysis, 28 patients were included in the baseline period, and 46 were included in the intervention period. At baseline, the percentage of patients achieving a TTR >60% varied between 33% and 45% (mean ± SD, 40% ± 5%); post-intervention, this metric improved and varied between 52% and 71% (mean ± SD, 61% ± 8%). In time-series analysis, there was evidence of statistically significant variation between the 2 periods and evidence of sustained improvement. CONCLUSIONS: A quality improvement program consisting of an audit-feedback report that raises awareness of the quality gap in TTR achievement can result in substantial improvement in the safe and efficacious administration of warfarin to patients receiving maintenance hemodialysis. |
format | Online Article Text |
id | pubmed-7000800 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-70008002020-02-10 Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin Blum, Daniel Beaubien-Souligny, William Battistella, Marisa Tseng, Eric Harel, Ziv Nijjar, Jaspreet Nazvitch, Elena Silver, Samuel A. Wald, Ron Kidney Int Rep Clinical Research INTRODUCTION: Studies have shown that achieving a time in therapeutic range (TTR) for warfarin of greater than 60% is associated with a lower risk of bleeding. However, many patients on hemodialysis (HD) do not achieve this target. METHODS: We audited TTR achievement at the in-center HD unit of our hospital in 2017 and found that only 40% of patients had achieved a TTR >60%. We aimed to improve the percentage of HD patients achieving target TTR within 2 years. We reported each patient's individualized trend in quarterly TTR to their primary warfarin prescriber as an audit-feedback report. These reports were generated, disseminated, and subsequently improved following a series of plan-do-study-act cycles. We then used statistical process control to assess for changes in the percentage of HD patients achieving target TTR over time. RESULTS: In the primary analysis, 28 patients were included in the baseline period, and 46 were included in the intervention period. At baseline, the percentage of patients achieving a TTR >60% varied between 33% and 45% (mean ± SD, 40% ± 5%); post-intervention, this metric improved and varied between 52% and 71% (mean ± SD, 61% ± 8%). In time-series analysis, there was evidence of statistically significant variation between the 2 periods and evidence of sustained improvement. CONCLUSIONS: A quality improvement program consisting of an audit-feedback report that raises awareness of the quality gap in TTR achievement can result in substantial improvement in the safe and efficacious administration of warfarin to patients receiving maintenance hemodialysis. Elsevier 2019-11-06 /pmc/articles/PMC7000800/ /pubmed/32043029 http://dx.doi.org/10.1016/j.ekir.2019.10.011 Text en © 2019 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Blum, Daniel Beaubien-Souligny, William Battistella, Marisa Tseng, Eric Harel, Ziv Nijjar, Jaspreet Nazvitch, Elena Silver, Samuel A. Wald, Ron Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin |
title | Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin |
title_full | Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin |
title_fullStr | Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin |
title_full_unstemmed | Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin |
title_short | Quality Improvement Program Improves Time in Therapeutic Range for Hemodialysis Recipients Taking Warfarin |
title_sort | quality improvement program improves time in therapeutic range for hemodialysis recipients taking warfarin |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000800/ https://www.ncbi.nlm.nih.gov/pubmed/32043029 http://dx.doi.org/10.1016/j.ekir.2019.10.011 |
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