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1 © 2004 TMIT TMIT 1 Value: Effective anti-coagulation management will be increasingly important to acute care hospital leaders. It is a key service tied to new Pay-For-Performance (P-4-P)programs, a therapy growing with our aging patient base, and one of the most frequent drugs involved in malpractice cases. There are new drugs on the horizon complicating the issue, however there are solutions that can help hospitals take an organized approach to this area. Evidence: Who benefits from such a program? The growing number of patients that are inadequately managed due to a lack of a systematic process who face disastrous consequences of preventable GI bleeding, CNS bleeding, and strokes due to clotting. Hospitals seeking to achieve the top tier performance in P-4-P: Payer programs such as the NQF Safe Practices initiative of the Leapfrog Group have identified this area as a high priority. It requires that hospitals have a systematic anticoagulation management program. What….are the key new solutions: Systematic anticoagulation Management (SAM). Originally developed through the Premier Innovation Institute, SAM has four elements: Management by qualified professional, scheduling and tracking, frequent accurate testing, and patient specific support and education. WebINR is a virtual anti-coagulation clinic, providing a web-based system for patients and physicians. Data is made available to physicians to monitor patient’s INR and provide decision support. WebINR also provides patient tracking, performance reports and patient education material at a low cost. It has demonstrated improvements of “in-range” INR values and reduced morbidity and mortality with patients. New Drug Exanta TM (Ximelagatran) is a potential replacement which does more required the same monitoring as warfarin. However, recent review by the FDA advisory panel indicates significant delay in its release. Furthermore, it is not indicated for heart valve patients which represent 1/3 of anti-coagulated patients. Where and when has this solution worked at frontline hospitals? Loma Linda VAMC has obtained great results using SAM with both reference lab and point of care testing devices – Preceptorship has been established and is open to all. El Camino Hospital – a 300 bed community hospital - has successfully implemented WebINR to monitor their patients with minimal investment Message: Why act now…why not wait…what if we pass? Act Now: In addition to preventing adverse events, and law suits a hospital has a robust anticoagulation clinic whereby a majority of the appropriate patients are managed after discharge, they will be prepared to meet future quality and P4P standards. There is still time to establish a program and receive recognition from payers and quality organizations. Wait: While certain evidence suggests that anticoagulation monitoring will not be necessary with new drugs such Exanta TM, another form of monitoring for liver enzyme levels may be required and will have to be addressed in a similar way. Hospitals that do not coordinate anticoagulation management will be at increased risk of litigation as such systematic management becomes standard of care. Pass: As time passes the risk will grow and it will be difficult for hospitals to catch up. If a competitor acts first you lose the lead role. Offering: How…..can a hospital get started? Contacts: Dr. Alan Jacobson (For Systematic Anti-coag Manag’t course) Ph Jerry L. Pettis V.A. Medical Franck Guilloteau, CTO TMIT Ph Resources: SAM Preceptorship – two day course at $300/person – contact Dr. Jacobson at The Anticoagulation Forum (ACF) is a network of anticoagulation experts who work together to ensure safe and effective antithrombotic therapy for patients all over the country. The Anticoagulation Therapy Management Certificate Program is a six- week, 40-hour course taught five to six times per year at the University of Southern Indiana School of Nursing and Health Professions Web Sites: - Anticoagulation Forum – WebINR service - Online Anticoagulation Therapy Management Certificate Program The CEO Solutions Series: Actionable Solutions for Senior Leaders Anti-coagulation Clinics: New Drivers – New Solutions
2 © 2004 TMIT TMIT Anticoagulation Clinics: New Drivers – New Solutions The CEO Solutions Series: Actionable Solutions for Senior Leaders
3 © 2004 TMIT TMIT Evidence Anticoagulation Management Services Anticoagulation therapy can reduce the risk for stroke by approximately 68%* Only 15% to 44% are prescribed warfarin* High impact – Strokes and Bleeds Warfarin Highly Litigated Drug New Drugs may confuse landscape *Source: Archives of Internal Medicine, 2000
4 © 2004 TMIT TMIT Evidence Payer Focus Service part of top tier requirement for Leapfrog NQF Safe Practices Leap Safe Practice with 4 th Highest Point Score in Survey 39/1000
5 © 2004 TMIT TMIT New Key Solutions…? Systematic Anticoagulation Management (SAM) Proven and Simple Minimal Hardware, software investment WebINR Bringing Patients and Physician Together New Drug Solutions Ximelagatran - Exanta TM
6 © 2004 TMIT TMIT Ongoing Patient Education Ongoing QI Direct Active Management by Qualified Health Care Provider Patient Scheduling and Tracking Accessible, Accurate, and Frequent PT/INR Testing Patient-specific Decision Support and Interaction Systematic Anticoagulation Management (SAM)
7 © 2004 TMIT TMIT WebINR Low Cost Web Based application Enables SAM – Tracking Patient, Decision Support and Education
8 © 2004 TMIT TMIT New Drug Exanta TM (Ximelagatran) Potential Warfarin Replacement with no Diet Restriction… However; Not indicated for Heart Valve Patients Recent FDA Advisory Panel vote Against release without further studies
9 © 2004 TMIT TMIT Anticoagulation Services Act Now: Minimal Investment and Great Outreach Program to the Community Meet future quality and P4P standards Delayed Action: Increased risk of lawsuits as systematic monitoring becomes standard of care. New Drugs such Exanta TM will still require some monitoring process Pass: Hospital cannot afford to “pass” - it is core to patient safety and providing quality care.
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