Jennifer Baker|Kristi L Pierce|Casey A Ryals
INR Goal Attainment and Oral Anticoagulation Knowledge of Patients Enrolled in an Anticoagulation Clinic in a Veterans Affairs Medical Center
VA Tennessee Valley Healthcare System
january 2009 joint commission implemented national patient safety goal npsg ambulatory care npsg 3e intended reduce harm associated use anticoagulation therapy 2011 npsg 3e encompasses 8 elements performance including requirements organization provide education regarding anticoagulation therapy staff patients families b evaluate safety practices take appropriate action improve practices alvin c york acy outpatient anticoagulation clinic provides education new patients families initial clinic visit followup reinforcement education needed throughout careto assess knowledge level patients receiving warfarin therapy anticoagulation clinic using validated anticoagulation knowledge assessment aka questionnaire b examine relationship patient anticoagulation knowledge anticoagulation control measured international normalized ratio inrall acy veterans affairs va anticoagulation clinic patients seen routine visit within 8week recruitment period february 2010 april 2010 asked complete aka questionnaire upon voluntary consent questionnaire completed patient either clinic visit returned later mail demographic clinical data manually extracted computerized patient record system included age gender indication duration anticoagulation therapy goal inr range 10 inr values preceding date consent passing score defined least 21 correct responses 29item aka questionnaire 724 correct statistical analyses included comparisons demographic clinical characteristics patients passing versus failing scores assessed pearson chisquare fishers exact test bivariate analyses inr control anticoagulation knowledge assessed spearmans rho correlation inr control defined 3 outcome measures number inrs within therapeutic range time therapeutic range ttr calculated using rosendaal method standard deviation sd inr values anticoagulation knowledge assessed 2 measures total aka score count correct answers subset 15 aka items deemed investigators relevant inr controlof 447 patients enrolled anticoagulation clinic 260 consented participate survey 185 patients completed aka instrument n171 924 mail successfully matched patient record system data 178 962 respondents male mean sd age 68 101 years majority patients undergoing anticoagulation treatment atrial fibrillation n113 611 deep venouspulmonary thromboembolism n48 259 majority patients treated warfarin least 1 year n162 876 patients goal inr ranges 20 30 n166 897 185 patients completed questionnaire 137 741 achieved passing score mean sd aka questionnaire score 781 121 8 questions answered correctly less 70 patients identified potential deficiencies patient education 167 patients warfarin therapy least 6 months 10 previous inr values significant spearmans rho correlation total number correct questionnaire responses inr control defined count 10 previous inr values within goal range rho 0022 p0776 ttr rho0015 p0848 sd rho0047 p0550 also significant relationship number correct inrrelevant responses inr control 3 outcome measures count range rho0033 p0676 ttr rho0067 p0388 sd rho0029 p0708although 741 patients longterm warfarin therapy achieved passing score least 21 correct answers 29question aka instrument significant relationship patient warfarin knowledge inr control areas improvement patient education identified procedures educational modification currently development