Warfarin use in atrial fibrillation patients at low risk for stroke: analysis of the Michigan Anticoagulation Quality Improvement Initiative (MAQI2)

2013 ◽  
Vol 37 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Geoffrey D. Barnes ◽  
Scott Kaatz ◽  
Julia Winfield ◽  
Xiaokui Gu ◽  
Brian Haymart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Quality Improvement ◽  
Low Risk ◽  
Quality Improvement Initiative

scholarly journals Effect of a pulmonary nodule fact sheet on patient anxiety and knowledge: a quality improvement initiative

2018 ◽  
Vol 7 (3) ◽  
pp. e000437 ◽  
Author(s):  
Matthew T Koroscil ◽  
Mitchell H Bowman ◽  
Michael J Morris ◽  
Andrew J Skabelund ◽  
Andrew M Hersh
Keyword(s):  
Lung Cancer ◽  
Quality Improvement ◽  
Pulmonary Nodule ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
Low Risk ◽  
Quality Improvement Initiative ◽  
Patient Anxiety ◽  
Patient Understanding ◽  
Fact Sheet

IntroductionThe utilisation of chest CT for the evaluation of pulmonary disorders, including low-dose CT for lung cancer screening, is increasing in the USA. As a result, the discovery of both screening-detected and incidental pulmonary nodules has become more frequent. Despite an overall low risk of malignancy, pulmonary nodules are a common cause of emotional distress among adult patients.MethodsWe conducted a multi-institutional quality improvement (QI) initiative involving 101 participants to determine the effect of a pulmonary nodule fact sheet on patient knowledge and anxiety. Males and females aged 35 years or older, who had a history of either screening-detected or incidental solid pulmonary nodule(s) sized 3–8 mm, were included. Prior to an internal medicine or pulmonary medicine clinic visit, participants were given a packet containing a pre-fact sheet survey, a pulmonary nodule fact sheet and a post-fact sheet survey.ResultsOf 101 patients, 61 (60.4%) worried about their pulmonary nodule at least once per month with 18 (17.8%) worrying daily. The majority 67/101 (66.3%) selected chemotherapy, chemotherapy and radiation, or radiation as the best method to cure early-stage lung cancer. Despite ongoing radiographic surveillance, 16/101 (15.8%) stated they would not be interested in an intervention if lung cancer was diagnosed. Following review of the pulmonary nodule fact sheet, 84/101 (83.2%) reported improved anxiety and 96/101 (95.0%) reported an improved understanding of their health situation. Patient understanding significantly improved from 4.2/10.0 to 8.1/10.0 (p<0.01).ConclusionThe incorporation of a standardised fact sheet for subcentimeter solid pulmonary nodules improves patient understanding and alleviates anxiety. We plan to implement pulmonary nodule fact sheets into the care of our patients with low-risk subcentimeter pulmonary nodules.

Abstract 096: Association of Body Mass Index With Bleeding in Patients Taking Warfarin for Atrial Fibrillation or Venous Thromboembolism

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kyle Stahlbaum ◽  
Eva Kline-Rogers ◽  
Xiaowen Kong ◽  
Geoffrey D Barnes ◽  
Brian Haymart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Quality Improvement ◽  
Venous Thromboembolism ◽  
Body Mass ◽  
Normal Weight ◽  
Risk Scores ◽  
Quality Improvement Initiative ◽  
Minor Bleeding ◽  
Life Threatening

Background: Most patients taking warfarin for atrial fibrillation (AF) and venous thromboembolism (VTE) have a target International Normalized Ratio (INR) between 2-3 to reduce risk of bleeding and thromboembolic events. Body Mass Index (BMI) is not included in traditional bleed risk scores, but may be an indicator of bleeding risk in warfarin patients. Methods: Using data from the multi-site Michigan Anticoagulation Quality Improvement Initiative (MAQI 2 ) Registry, we identified all AF/VTE patients , separated them into three cohorts: BMI < 20 (underweight), BMI 20-25 (normal weight) and BMI >25 (overweight). Bleeding events in these cohorts were identified and stratified into severity according to International Society of Thrombosis and Hemostasis criteria. Results: Of 6,054 patients, 4,766 (78.7%) had a BMI of > 25. These patients were generally younger, with higher prevalence of hypertension. The HAS-BLED scores were slightly lower in overweight AF patients (2.6 vs 2.8; p=0.04); otherwise no difference between groups. The overall minor, major, and life threatening bleeding rates were 22.8/27.7; 4.3/3.7; and 1.2/0.7 (per 100 patient years) in AF and VTE patients, respectively. A higher proportion of females were underweight for both indications, and AF patients were older. More underweight and normal weight AF and VTE patients had a bleeding history compared to overweight patients. Bleeding outcomes are listed in Table. Comparisons were made with Poisson regression analysis. Conclusion: In a large, unselected cohort of warfarin treated patient from a multi-site registry, minor bleeding was more common in underweight and normal weight AF patients; major and life-threatening bleeding was more common in underweight and normal weight VTE patients. Since the majority of patients were overweight, further studies are needed to determine if reasons for bleeding differ between patients based on BMI in order to guide quality improvement efforts.

scholarly journals A Quality Improvement Initiative to Reduce Hospitalizations for Low-risk Diabetic Ketoacidosis

PEDIATRICS ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. e20191104
Author(s):  
Kelly R. Bergmann ◽  
M. Jennifer Abuzzahab ◽  
Joe Arms ◽  
Gretchen Cutler ◽  
Heidi Vander Velden ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Diabetic Ketoacidosis ◽  
Low Risk ◽  
Quality Improvement Initiative

scholarly journals Reducing caesarean section rate in an urban hospital serving women attending privately in India – a quality improvement initiative

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Abhishek Bhartia ◽  
Rinku Sen Gupta Dhar ◽  
Saru Bhartia
Keyword(s):  
Quality Improvement ◽  
Caesarean Section ◽  
Post Partum ◽  
Healthcare Setting ◽  
Low Risk ◽  
Quality Improvement Initiative ◽  
Group Practice ◽  
Full Time ◽  
First Birth ◽  
Labour Ward

Abstract Background In line with global trends, India has witnessed a sharp rise in caesarean section (CS) deliveries, especially in the private sector. Despite the urgent need for change, there are few published examples of private hospitals that have successfully lowered their CS rates. Our hospital, serving private patients too, had a CS rate of 79% in 2001. Care was provided by fee-for-service visiting consultant obstetricians without uniform clinical protocols and little clinical governance. Consultants attributed high CS rate to case-mix and maternal demand and showed little inclination for change. We attempted to reduce this rate with the objective of improving the quality of our care and demonstrating that CS could be safely lowered in the private urban Indian healthcare setting. Methods We hired full-time salaried consultants and began regular audit of CS cases. When this proved inadequate, we joined an improvement collaborative in 2011 and dedicated resources for quality improvement. We adopted practice guidelines, monitored outcomes by consultant, improved labour ward support, strengthened antenatal preparation, and moved to group practice among consultants. Results Guidelines ensured admissions in active labour and reduced CS (2011 to 2016) for foetal heart rate abnormalities (23 to 5%; p < 0.001) and delayed progress (19 to 6%; p < 0.001) in low-risk first-birth women. Antenatal preparation increased trial of labour, even among women with prior CS (28 to 79%; p < 0.001). Group practice reduced time pressure and stress, with a decline in CS (52 to 18%; p < 0.001) and low-risk first-birth CS (48 to 12%; p < 0.001). Similar CS rates were maintained in 2017 and 2018. Measures of perinatal harm including post-partum haemorrhage, 3rd-4th degree tears, shoulder dystocia, and Apgar < 7 at 5 min were within acceptable ranges (13, 3, 2% and 3 per thousand respectively in 2016–18,). Conclusions It is feasible to substantially reduce CS rate in private healthcare setting of a middle-income country like India. Ideas such as moving to full-time attachment of consultants, joining a collaborative, improving labour ward support, providing resources for data collection, and perseverance could be adopted by other hospitals in their own journey of moving towards a medically justifiable CS rate.

scholarly journals Rationale and design of the improving Care for Cardiovascular Disease in China (CCC) project: a national registry to improve management of atrial fibrillation

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020968 ◽  
Author(s):  
Yongchen Hao ◽  
Jing Liu ◽  
Sidney C Smith ◽  
Yong Huo ◽  
Gregg C Fonarow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Quality Improvement ◽  
Anticoagulation Therapy ◽  
Clinical Information ◽  
Heart Association ◽  
National Registry ◽  
Hospital Quality ◽  
Quality Improvement Initiative ◽  
Chinese Society

IntroductionInadequate management of patients with atrial fibrillation (AF) has been reported in China for anticoagulation therapy and treatment for concomitant diseases. An effective quality improvement programme has been lacking to promote the use of evidence-based treatments and improve outcome in patients with AF.Methods and analysisThe Improving Care for Cardiovascular Disease in China-AF programme is a collaboration of the American Heart Association and the Chinese Society of Cardiology. This programme is designed to promote adherence to AF guideline recommendations and outcomes for inpatients with AF. Launched in February 2015, 150 hospitals are recruited by geographic-economic regions across 30 provinces in China. Each month, 10–20 inpatients with AF are enrolled in each hospital. A web-based data collection platform is used to collect clinical information for patients with AF, including patients’ demographics, admission information, medical history, in-hospital care and outcomes, and discharge medications for managing AF. The quality improvement initiative includes monthly benchmarked reports on hospital quality, training sessions, regular webinars and recognitions of hospital quality achievement. Primary analyses will include adherence to performance measures and guidelines. To address intrahospital correlation, generalised estimating equation models will be applied. As of March 2017, 28 801 AF inpatients have been enrolled.Ethics and disseminationThis study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. Results will be published in peer-reviewed medical journals.Trial registration numberNCT02309398.

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