Improving Safe Use of Direct Oral Anticoagulants: A Population Health Approach

项目总结/摘要 这项研究将评估人口健康方法的实施情况，以确保适当的 抗凝剂处方在不同的收集卫生系统。我们将首先评估执行情况 直接口服抗凝剂（DOAC）仪表板已用于退伍军人 自2016年以来，卫生事务（VHA）卫生系统。这将通过结合VHA DOAC仪表板来完成 数据库与VHA企业数据仓库，国家死亡指数，和VHA收费服务数据集。 评估将遵循覆盖范围、有效性、采用、实施和维护（RE-AIM） 评价模型然后，我们将研究VHA内实施成功的决定因素， 综合卫生系统，以及参与密歇根州的非VHA卫生系统的集合 抗凝质量改进计划（MAQI 2），以确定 使用这个工具。为此，我们将与VHA的主要利益相关者进行半结构化访谈 使用DOAC仪表板的站点有高、中、低使用率，以及计划实施 MAQI 2中的仪表板。这些面试将使用基于定制的模板分析进行评估 慢性病实施（TICD）清单和技术接受模型。最后我们将 在MAQI 2联盟内实施和评估DOAC仪表板。我们将再次使用RE-AIM 评估框架，并利用现有的MAQI 2数据库进行分析。这项研究的结果将 导致安全管理的改善和口服处方患者不良药物事件的减少 抗凝药物这项研究还将确定执行方法上的重要区别 在完全一体化的卫生系统和传统的卫生系统之间使用人口卫生工具。

Project Summary/Abstract This study will evaluate the implementation of a population health approach to ensuring appropriate anticoagulant prescribing in a diverse collection of health systems. We will first evaluate the implementation and effectiveness of the direct oral anticoagulant (DOAC) dashboard that has been used in the Veterans Health Affairs (VHA) health system since 2016. This will be done by combining the VHA DOAC Dashboard database with the VHA Corporate Data Warehouse, national death index, and VHA fee-for-service datasets. The evaluation will follow the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) evaluation model. Then, we will study the determinants of implementation success within the VHA, a fully integrated health system, as well as within a collection of non-VHA health systems participating in the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) to identify differences in the barriers and facilitators of implementing this tool. To do this, we will conduct semi-structured interviews with key stakeholders at VHA sites with high, moderate, and low usage of the DOAC Dashboard as well as sites planning to implement the dashboard within MAQI2. These interviews will be evaluated using template analysis based on the Tailored Implementation in Chronic Disease (TICD) checklist and the Technology Acceptance Model. Finally, we will implement and evaluate the DOAC Dashboard within the MAQI2 consortium. We will again use the RE-AIM evaluation framework and leverage the existing MAQI2 database for analyses. Findings from this study will lead to improvements in safe management and a reduction in adverse drug events for patients prescribed oral anticoagulant medications. This study will also identify important differences in the implementation approach for population health tools between fully integrated and traditional health systems.