PB0028 - Multi-center Adoption and Impact of a DOAC Dashboard to Reduce Off-Label DOAC Prescribing

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Geoffrey Barnes, MD, MSc

Cardiologist and Vascular Medicine Specialist
University of Michigan
Ann Arbor, Michigan, United States

Co-Author(s)

BH

Brian Haymart

Project Manager
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Ann Arbor, Michigan, United States
JS

Jake Seagull

Project Manager
University of Michigan
Ann Arbor, Michigan, United States
NR

Noelle Ryan

Pharmacist
Division of Hospital Medicine; Anticoagulation Services, Henry Ford Health, Detroit, MI
Detroit, Michigan, United States
SE

Stacy Ellsworth

Clinical Research Coordinator
Henry Ford Health System
Detroit, Michigan, United States
ER

Elizabeth Renner

Pharmacist
University of Michigan
Ann Arbor, Michigan, United States
MD

Mary Jo DeYoung

Anticoagulation Nurse Manager
Corewell West
Grand Rapids, Michigan, United States
MA

Mona A. Ali

Pharmacist
Department of Heart and Vascular Services, Corewell Health William Beaumont University Hospital, Royal Oak, MI
Royal Oak, Michigan, United States
Scott Kaatz, DO, MSc

Co-director, Anticoagulation Clinics
Division of Hospital Medicine; Anticoagulation Services, Henry Ford Health, Detroit, MI
Detroit, Michigan, United States
JF

James B. Froehlich

Professor
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Ann Arbor, Michigan, United States
ML

Michael Lanham

Assistant Professor
University of Michigan
Ann Arbor, Michigan, United States

Background: Direct oral anticoagulants (DOAC) are prescribed inappropriately in up to 25% of patients. Population health approaches have been proposed as an efficient means for reviewing and fixing off-label DOAC prescriptions.

Aims: To evaluate the adoption and effectiveness of a population health DOAC Dashboard in four large US health systems.

Methods: We developed and implemented an electronic heath record DOAC “Dashboard” for population health management of ambulatory DOAC prescriptions. Nurses and/or pharmacists in four health systems participating in the Michigan Anticoagulation Quality Improvement Initiative were empowered to contact prescribing clinicians when a known DOAC prescription error was found on the DOAC Dashboard. We report on the number of total patients prescribed DOAC medications, the number of off-label DOAC prescriptions identified, and the number of DOAC prescription interventions made at each hospital quarterly between July 1, 2020 and December 31, 2023.

Results: The total number of ambulatory DOAC patients increased steadily at three of the four hospitals, averaging 821 (95% CI 11 fewer to 1654 more) new patients per quarter (Figure 1). There was a high degree of heterogeneity by site and time in the number of alerts addressed each quarter (Figure 2). The overall percent of patients with a DOAC prescription error declined for Hospital B (-0.25%/quarter, 95% CI -0.16 to -0.33%/quarter) and Hospital C (-0.19%/quarter, 95% CI -0.02 to -0.37%) after two quarters of initial DOAC Dashboard use (Figure 2). Hospitals A and D had no statistically significant change in the percent of DOAC prescription errors during the study period.

Conclusion(s): A population health approach to appropriate DOAC prescribing can be successfully adopted, leading to reductions in the rate of off-label DOAC dosing. Further studies are needed to understand how best to use a DOAC Dashboard to reduce off-label DOAC prescribing given center-level variation.