Performance measures cut costs, improve care in warfarin patients

Not having set guidelines for managing patients on warfarin is costing hospitals and physicians a fortune. Researchers from Boston University School of Medicine (BUSM) have developed new performance measures to help these clinicians improve the management of patients on warfarin.

One of the common anticoagulants, warfarin is used by million in the U.S. Warfarin management can be measured by the time patients spend on the therapeutic range—or when they are considered to be protected from blood clots and not at risk of bleeding—but clinicians often differ in defining this range. The BUSM study hoped to prove that set guidelines of defining warfarin management can save money and improve care within a health network.

The study included more than 5,000 patients from eight VAs and compared them to patients receiving warfarin from other providers. Results showed that patients monitored using the performance measures developed by BUSM were doing comparatively better than those outside the BUSM guidelines.

"This study serves as a model for how other sites and health networks could feasibly approach improving the management of warfarin in their systems,” said corresponding author Adam Rose, MD, associate professor of medicine at BUSM. “If all anticoagulation clinics in the VA were to achieve this level of improvement, it would prevent 48 strokes and 68 major bleeding events each year, with a savings to the VA system of more than $4 million annually. Insufficient attention has been given in the past to how we can improve the management of warfarin. This study demonstrates that a relatively simple approach can have a large impact."