THERAPEUTIC OUTCOMES POST-APPLICATION OF A COMPUTERISED ANTITHROMBOTIC RISK ASSESSMENT TOOL (CARAT) FOR THERAPEUTIC DECISION-MAKING IN A COHORT OF AUSTRALIAN PATIENTS WITH ATRIAL FIBRILLATION

2017 ◽  
Author(s):  
Beata Bajorek
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Decision Making ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Therapeutic Decision ◽  
Therapeutic Outcomes ◽  
Therapeutic Decision Making

scholarly journals Improving VTE risk assessment and prophylaxis prescribing rate in medical patients: integrating risk assessment tool into the workflow

2020 ◽  
Vol 9 (2) ◽  
pp. e000903
Author(s):  
Hannah Preston ◽  
Iain Swan ◽  
Lauren Davies ◽  
Simon Dummer ◽  
Veiraiah Aravindan ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Assessment Tool ◽  
Qualitative Interviews ◽  
Baseline Period ◽  
Risk Assessment Tool ◽  
Medical Patients ◽  
Seamless Integration ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis

Medical inpatients often have important risk factors for venous thromboembolism (VTE). In our institution, VTE prophylaxis in this group was underused. The main barriers identified were inattention to VTE prophylaxis, competing priorities and lack of confidence in the decision-making. We aimed to improve the rate of VTE prophylaxis use by introducing a paper-based risk assessment tool, with actionable management recommendations within the prescription chart. The rationale was that an assessment tool at the point of prescribing can reduce steps between decision-making and prescribing process, thus promoting confidence and acting as a reminder. A total of 552 prescription charts completed over a period of 29 weeks were examined during the baseline period. In the postintervention period, 871 charts completed over 40 weeks period were examined. The risk assessment tool was completed in 51% of the cases examined in the postintervention period. The introduction of the risk assessment tool was associated with a significant change in the pattern of VTE pharmacological prophylaxis use. The change occurred when the form was made highly visible and enclosed in the prescription chart. The pharmacological prophylaxis use was higher with a completed assessment form than without (mean (SD) 97.5% (7.6%) vs 70.1% (19.4%); p<0.0001). The rate of appropriate prophylaxis decision was 98.2% (SD 5.2%) with a completed assessment form, and 80.7% (SD 17.9%) when it was not used. The qualitative interviews revealed positive themes; many users found it useful, easy and convenient to use. Our data have shown that a paper-based VTE risk assessment tool placed within the prescription chart could substantially improve the rate of appropriate assessment and VTE prophylaxis implementation. This suggests that tool clearly needs to be a seamless integration into the workflow to capture users’ attention and mitigate the influence of time perception.

scholarly journals Mental Health Risk Factors and Parole Decisions: Does Inmate Mental Health Status Affect Who Gets Released

2019 ◽  
Vol 16 (16) ◽  
pp. 2950 ◽  
Author(s):  
Kimberly A. Houser ◽  
E. Rely Vîlcică ◽  
Christine A. Saum ◽  
Matthew L. Hiller
Keyword(s):  
Mental Health ◽  
United States ◽  
Risk Assessment ◽  
Decision Making ◽  
Mental Illness ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Parole Board ◽  
Health Factors ◽  
Mental Health Factors

Parole decision—the decision to release an incarcerated individual from prison conditionally—is one of the most critical decisions across justice systems around the world. The decision carries with it significant consequences: for the freedom of the individual awaiting release (the parolee); for the safety of the community in which they will return; and for the correctional system overall, especially its organizational capacity. The current study attempts to add to the parole decision-making literature by specifically analyzing the role that mental health factors may play in explaining parole decisions. Research to date is inconclusive on whether or not mental illness is a risk factor for criminal behavior; despite this, individuals with mental health problems generally fare worse on risk assessment tools employed in justice decisions. The study relies on a 1000+ representative sample of parole-eligible individuals in Pennsylvania, United States. To increase reliability, the analyses test for several mental health factors based on information from different sources (i.e., self-reported mental health history; risk assessment tool employed by the Parole Board; and risk assessment tool employed by the Department of Corrections). To address validity concerns, the study controls for other potential correlates of parole decisions. Although the multivariate models explained a considerable amount of variance in parole decisions, the inclusion of mental health variables added relatively little to model fit. The results provide insights into an understudied area of justice decision making, suggesting that despite the stigmatization of mental illness among criminal justice populations, parole board members in Pennsylvania, United States, appear to follow official guidelines rather than to consider more subjective notions that poor mental health should negate parole release.

Considerations when choosing an appropriate bleeding risk assessment tool for patients with atrial fibrillation

2020 ◽  
Vol 18 (4) ◽  
pp. 788-790 ◽  
Author(s):  
Wern Yew Ding ◽  
Stephanie L. Harrison ◽  
Deirdre A. Lane ◽  
Gregory Y. H. Lip
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Assessment Tool ◽  
Bleeding Risk ◽  
Risk Assessment Tool

scholarly journals Impact of a Computerized Antithrombotic Risk Assessment Tool on the Prescription of Thromboprophylaxis in Atrial Fibrillation: Hospital Setting

2016 ◽  
Vol 24 (1) ◽  
pp. 85-92 ◽  
Author(s):  
E. Pandya ◽  
N. Masood ◽  
Y. Wang ◽  
I. Krass ◽  
B. Bajorek
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Stroke Risk ◽  
Assessment Tool ◽  
Oral Anticoagulants ◽  
Hospital Setting ◽  
Bleeding Risk ◽  
Risk Assessment Tool ◽  
Treatment Recommendation ◽  
Nonvalvular Atrial Fibrillation

The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient’s stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers’ treatment selection were identified. The CARAT recommended a change in baseline therapy for 51.8% of patients. Among anticoagulant-eligible patients (ie, where the risk of stroke outweighed the risk of bleeding) using “nil therapy” or antiplatelet therapy at baseline, the CARAT recommended an upgrade to warfarin in 60 (30.8%) patients. For those in whom the bleeding risk outweighed the stroke risk, the CARAT recommended a downgrade from warfarin to safer alternatives (eg, aspirin) in 37 (19%) patients. Among the “most eligible” (ie, high stroke risk, low bleeding risk, no contraindications; n = 75), the CARAT recommended warfarin for all cases. Discharge therapy observed a marginal increase in anticoagulation prescription in eligible patients (n = 116; 57.8% vs 64.7%, P = .35) compared to baseline. Predictors of warfarin use (vs antiplatelets) included congestive cardiac failure, diabetes mellitus, and polypharmacy. The CARAT was able to optimize the selection of therapy, increasing anticoagulant use among eligible patients. With the increasing complexity of decision-making, such tools may be useful adjuncts in therapy selection in atrial fibrillation. Future studies should explore the utility of such tools in selecting therapies from within an expanded treatment armamentarium comprising the non-vitamin K antagonist oral anticoagulants.

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