Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO02 - Poster Session II (ID 47) Poster

D-PO02-121 - Implementation And Maintenance Of Guideline Driven Atrial Fibrillation Clinical Pathway Improves Patient Outcomes (ID 216)


Background: Hospital AF management varied significantly across providers and subspecialties, impacting clinical outcomes.
Objective: A guideline-driven clinical AF pathway (AFP) in a community hospital setting improves patient (pt) care and experience at reduced cost.
Methods: At the direction of a multidisciplinary team, the AFP was implemented in 2016 and maintained for three years. The AFP aided in medication selection for anticoagulation (IV heparin vs. direct oral anticoagulant (DOAC)/continuation of warfarin) and rate control (IV diltiazem vs. oral metoprolol) in pts with a primary admitting diagnosis of AF. Medication choices and outcomes three years post-implementation were compared to one-year pre-implementation. Intermediate outcomes measured included ICU admits, number of labs ordered and length of stay. Final outcomes included total variable cost, 30-day readmission rates and 90-day post discharge strokes rates.
Results: From October 2015 to July 2019, a total of 2,492 pts were treated for acute AF of which 837 pts were admitted for AF. Linear regression models for continuous measures and logistic regression models for binary measures demonstrated continued adherence to the pathway (p<0.001) with fewer lab tests (p=0.0008), decreased cost (p=0.0147) and lower stroke rates (p = 0.0023) in the post-implementation period.
Conclusion: Both implementation and the maintenance of the AFP led to better pt care, decreased rate of 90-day post discharge ischemic stroke, and improved pt experience at a lower cost of care. These favorable outcomes may be due to the decreased clinician variability of care.