Comparison of Two Different Models of Anticoagulation Management Services with Usual Medical Care
Comparison of Two Different Models of Anticoagulation Management Services with Usual Medical Care
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DOI：
10.1592/phco.30.4.330
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发表时间：
2010-04-01
期刊：
影响因子：
4.1
通讯作者：
Dier, John G.
中科院分区：
文献类型：
--
作者：
Rudd, Kelly M.;Dier, John G.
研究目的。评价三种抗凝管理服务模式的安全性和经济影响：常规医疗护理、护士管理服务和药剂师管理服务。回顾性病历审查。设置。纽约州中部的八个县的医疗保健系统。996名患者（年龄范围19-99岁）接受华法林治疗至少6个月，并且在1年研究期间报告了3个或更多国际标准化比值（INR）值; 489例患者（6243 INR值）在药剂师管理组中，307例患者200名患者（3618 INR值）在护士管理组中，200名患者（3142 INR值）在常规护理组中。所有INR测量均由中心实验室或现场床旁检测进行。查询了2003日历年的常规护理和护士管理服务数据以及2006日历年的药剂师管理服务数据。从病历中提取抗凝适应症、INR目标、基线特征以及与抗凝治疗直接相关的住院和急诊就诊率和费用。如果未记录INR目标，则根据美国胸科医师学会抗凝指南适当指定范围。计算每个研究组的抗凝控制时间范围内的标志物（患者维持在其治疗范围内的时间百分比）和INR值范围内的百分比。所有研究组的基线特征相似。药剂师管理的服务产生了最低的住院率和急诊就诊率，与护士管理的服务相比，住院率降低了56%，与常规护理相比降低了61%（p
Study Objective. To evaluate the safety and economic impact of three models of anticoagulation management services: usual medical care, a nurse-managed service, and a pharmacist-managed service.Design. Retrospective medical record review.Setting. An eight-county health care system in central New York State.Patients. Nine hundred ninety-six patients (age range 19-99 yrs) who were receiving warfarin therapy for at least 6 months and who had three or more international normalized ratio (INR) values reported during the 1-year study period; 489 patients (6243 INR values) were in the pharmacist-managed group, 307 patients (3618 INR values) were in the nurse-managed group, and 200 patients (3142 INR values) were in the usual care group.Measurements and Main Results. All INR measurements were performed by the central laboratory or by on-site point-of-care testing. Data were queried from calendar year 2003 for the usual care and nurse-managed services and calendar year 2006 for the pharmacist-managed service. Anticoagulation indication, INR goal, baseline characteristics, and rates and costs of hospitalization and emergency department visits directly related to anticoagulation therapy were extracted from the medical record. If the INR goal was not documented, a range was assigned as appropriate from the American College of Chest Physicians anticoagulation guidelines. Markers of anticoagulation control time in range (percentage of time a patient is maintained within their therapeutic range) and percentage of INR values in range were calculated for each study group. Baseline characteristics were similar among all study groups. The pharmacist-managed service yielded the lowest rates of hospitalization and emergency department visits, with hospitalizations reduced by 56% versus nurse-managed service and 61% versus usual care (p