Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol

Geoffrey D Barnes, Emily Sippola, Michael Dorsch, Joshua Errickson, Michael Lanham, Arthur Allen, Patrick Spoutz, Anne E Sales, Jeremy Sussman, Geoffrey D Barnes, Emily Sippola, Michael Dorsch, Joshua Errickson, Michael Lanham, Arthur Allen, Patrick Spoutz, Anne E Sales, Jeremy Sussman

Abstract

Background: Use of direct oral anticoagulants (DOAC) is rapidly growing for treatment of atrial fibrillation and venous thromboembolism. However, incorrect dosing of these medications is common and puts patients at risk of adverse drug events. One way to improve safe prescribing is the use of population health tools, including interactive dashboards built into the electronic health record (EHR). As such tools become more common, exploring ways to understand which aspects are effective in specific settings and how to effectively adapt and implement in existing anticoagulation clinics across different health systems is vital.

Methods: This three-phase project will evaluate a current nation-wide implementation effort of the DOAC Dashboard in the Veterans Health Administration (VHA) using both quantitative and qualitative methods. Informed by this evaluation, the DOAC Dashboard will be implemented in four new health systems using an implementation strategy derived from the VHA experience and interviews with providers in those new health systems. Quantitative evaluation of the VHA and non-VHA implementation will follow the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Qualitative interviews with stakeholders will be analyzed using the Consolidated Framework for Implementation Research and Technology Acceptance Models to identify key determinants of implementation success.

Discussion: This study will (1) evaluate the implementation of an EHR-based population health tool for medication management within a large, nation-wide, highly integrated health system; (2) guide the adoption in a set of four different health systems; and (3) evaluation that multi-center implementation effort. These findings will help to inform future EHR-based implementation efforts in a wide variety of health care settings.

Keywords: Anticoagulant; Electronic health records; Implementation science; Medication errors; Pharmacists.

Conflict of interest statement

GB—consulting for Pfizer/Bristol-Myers Squibb, Janssen, Portola, and Acelis Connected Health; Grant funding from Pfizer/Bristol-Myers Squibb, Blue Cross-Blue Shield of Michigan

AA—consulting for Pfizer/Bristol-Myers Squibb and Roche Diagnostics; Speaking Bureaus for Janssen and Portola

All others—no disclosures

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