Implementing A Population Health Approach to Direct Oral Anticoagulation Management - Phase II
by Katelyn A. Harris, PharmD, Julie C. Bartell, PharmD, BCACP, FPSW
Abstract:
Objective:
To optimize direct oral anticoagulant (DOAC) trigger rules developed during phase I and to standardize the patient outreach process.
Methods:
A process improvement project that involved the implementation of a DOAC monitoring program developed during phase I into SSM Health Monroe Clinic’s electronic health record (EHR) system. This program identified patients on inappropriate DOAC doses or with contraindications to DOAC therapy. Pharmacists used a patient outreach approach to contact these patients and appropriately change their therapy when indicated.
Results:
Measurements were taken during two go live periods that were each 3 months in length. Type of alert, trigger rule firing accuracy, and results of intervention if needed were documented using a standardized EHR documentation template. Results were analyzed at the end of both go-lives. At the end of the first go-live, there were a total of 38 trigger alerts, with 13 requiring pharmacist intervention (34%). At the end of the second go-live, there were a total of 6 trigger alerts, of which 4 (66.7%) required pharmacist intervention after trigger rule adjustments were made.
Conclusion:
The reduced number of inaccurate alerts between the first and second go-live reassures us that the trigger rule adjustments improved rule accuracy. As DOAC popularity continues to increase, this EHR DOAC monitoring system could be a valuable tool to prevent incidence of stroke, VTE, and/or bleeding events as a result of unsafe and inappropriate DOAC use.
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2025 September/October Table of Contents
Abstract:
Objective:
To optimize direct oral anticoagulant (DOAC) trigger rules developed during phase I and to standardize the patient outreach process.
Methods:
A process improvement project that involved the implementation of a DOAC monitoring program developed during phase I into SSM Health Monroe Clinic’s electronic health record (EHR) system. This program identified patients on inappropriate DOAC doses or with contraindications to DOAC therapy. Pharmacists used a patient outreach approach to contact these patients and appropriately change their therapy when indicated.
Results:
Measurements were taken during two go live periods that were each 3 months in length. Type of alert, trigger rule firing accuracy, and results of intervention if needed were documented using a standardized EHR documentation template. Results were analyzed at the end of both go-lives. At the end of the first go-live, there were a total of 38 trigger alerts, with 13 requiring pharmacist intervention (34%). At the end of the second go-live, there were a total of 6 trigger alerts, of which 4 (66.7%) required pharmacist intervention after trigger rule adjustments were made.
Conclusion:
The reduced number of inaccurate alerts between the first and second go-live reassures us that the trigger rule adjustments improved rule accuracy. As DOAC popularity continues to increase, this EHR DOAC monitoring system could be a valuable tool to prevent incidence of stroke, VTE, and/or bleeding events as a result of unsafe and inappropriate DOAC use.
Download PDF
2025 September/October Table of Contents