Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-121 - Improving Atrial Fibrillation Stroke Risk Documentation In The Cardiovascular Clinic: A Quality Improvement Initiative (ID 331)

 K. Xiang: Nothing relevant to disclose.


Background: Embolic stroke is a leading cause of death and disability in patients with atrial fibrillation (AF). The risk of stroke can be reduced by appropriate anticoagulation.
Objective: We aimed to identify patterns of decision making where anticoagulation was withheld in our cardiovascular clinic, and to intervene to improve our rate of appropriate anticoagulation for AF patients.
Methods: Outpatient clinic visits from 9/2018 to 3/2019 at UF Health Jacksonville were screened for ICD-10 discharge diagnoses related to AF. Demographic data was recorded, CHA2DS2-VASc scores were calculated and the type of anticoagulation or documented reasons for withholding anticoagulation were recorded. Baseline anticoagulation appropriateness was calculated based on the National Quality Forum (NQF) algorithm. A worksheet was placed in clinic rooms to prompt physicians to calculate and document their patient’s CHA2DS2-VASc scores. Three rounds of Plan-Do-Study-Act were carried out from 5-6/2019 at one cycle per week for one month and post-intervention anticoagulation rates were recalculated.
Results: Patient demographics were 52% male, 37.8% African American and 56.8% Caucasian. Mean age of patients was 68 years. The mean CHA2DS2-VASc score was 3.59 (SD 1.6), but as high as 4.62 in Interventional Cardiology clinic. Stroke risk was not documented in 29% of fellows’ clinic visits, compared to 58% of faculty visits. DOAC use rate was higher in fellows’ clinic compared to faculty clinics -69% vs 57% - owing to a low-cost or no-cost prescription plans). There were no significant differences in prescription rates or appropriateness of care based on ethnicity. By the NQF algorithm, 96% of patient visits met appropriate performance for prescribing or documenting desire to not use an anticoagulant. Following our three PDSA cycles, the rate of correct CHA2DS2-VASc documentation rose from 29% to 90%.
Conclusion: A simple yet strategically placed reminder in patient treatment rooms can help improve documentation rates. The next step is converting this reminder into a Best Practice Advisory in the electronic health record system to assess adherence.