PB0493 - Reach, Adoption, and Maintenance of a Population Health Dashboard for Safe DOAC Prescribing: Insights from the United States Veterans Health Affairs

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Geoffrey Barnes, MD, MSc

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

Co-Author(s)

CC

Charity Chen

Analyst
Ann Arbor VA Center for Clinical Management Research
Ann Arbor, Michigan, United States
PS

Patrick Spoutz

Database Programmer
Veterans Affairs
Boise, Idaho, United States
AA

Arthur Allen

Pharmacist
VA Salt Lake City
Salt Lake City, Utah, United States
JS

Jake Seagull

Research Coordinator
University of Michigan
Ann Arbor, Michigan, United States
JS

Jeremy Sussman

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
MD

Michael Dorsch

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

Background: Direct oral anticoagulants (DOACs) are first line treatment for venous thrombosis and atrial fibrillation, but inappropriately prescribed for up to 1 in 7 patients. In 2016, the United States Veterans Health Affairs (VHA) implemented a population health dashboard to facilitate pharmacist monitoring of outpatient DOAC use.

Aims: To comprehensively analyze the nationwide VHA implementation of this novel care delivery model that aims to promote safe, evidence-based anticoagulant prescribing.

Methods: This retrospective analysis was conducted using dashboard log-in data across all 164 VHA sites between August 2016 and June 2020. Using the RE-AIM implementation science evaluation framework, we calculated the reach (number of DOAC-treated patients at sites with any dashboard use), adoption (number of VHA sites and total staff members with regular dashboard use), and maintenance (dashboard use 2+ days per month for at least 6 months) at the site-level. Post-hoc, we defined four phases of adoption (early, growth, full use, steady state) based on the pattern of dashboard use.

Results: The dashboard’s reach increased from an average of 413 to 1875 patients per site, achieving a maximum of 258,230 patients across 138 sites by June 2020. Early adoption was slow but then rapidly grew to 67 sites & 224 staff by December 2017 and to 130 sites & 627 staff during the full use phase (December 2018). Dashboard use was maintained (6+ months of consecutive use) by 18/36 (50%) sites by December 2017, 69/128 (54%) of sites by December 2018, and 126/150 (84%) sites by June 2020.

Conclusion(s): Nation-wide use of a dashboard for safe DOAC prescribing followed a typically diffusion of innovation curve for reach and adoption. There was high site-level sustained use between January 2019 and June 2020. How this novel electronic health tool and model of care impacted quality and outcomes remains to be assessed.