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Allen AL, Lucas J, Parra D, et al. Shifting the Paradigm: A Population Health Approach to the Management of Direct Oral Anticoagulants. J Am Heart Assoc. 2021;10(24):e022758doi: 10.1161/JAHA.121.022758.
Allen, A. L., Lucas, J., Parra, D., Spoutz, P., Kibert, J. L., Ragheb, B., Chia, L., & Sipe, A. (2021). Shifting the Paradigm: A Population Health Approach to the Management of Direct Oral Anticoagulants. Journal of the American Heart Association, 10(24), e022758. https://doi.org/10.1161/JAHA.121.022758
Allen, Arthur L, et al. "Shifting the Paradigm: A Population Health Approach to the Management of Direct Oral Anticoagulants." Journal of the American Heart Association vol. 10,24 (2021): e022758. doi: https://doi.org/10.1161/JAHA.121.022758
Allen AL, Lucas J, Parra D, Spoutz P, Kibert JL, Ragheb B, Chia L, Sipe A. Shifting the Paradigm: A Population Health Approach to the Management of Direct Oral Anticoagulants. J Am Heart Assoc. 2021 Dec 21;10(24):e022758. doi: 10.1161/JAHA.121.022758. Epub 2021 Nov 19. PMID: 34796718.
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J Am Heart Assoc. 2021 Dec 21;10(24):e022758. doi: 10.1161/JAHA.121.022758. Epub 2021 Nov 19.

Shifting the Paradigm: A Population Health Approach to the Management of Direct Oral Anticoagulants.

Journal of the American Heart Association

Arthur L Allen, Jessica Lucas, David Parra, Patrick Spoutz, Jeffery L Kibert, Bishoy Ragheb, Linda Chia, Amy Sipe

Affiliations

  1. Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.
  2. North Florida/South Georgia Veterans Affairs Health Care System Gainesville FL.
  3. Pharmacy Benefits Management Veterans Integrated Service Network 8 Bay Pines FL.
  4. University of Minnesota College of Pharmacy Minneapolis MN.
  5. Pharmacy Benefits Management Veterans Integrated Service Network 20 Vancouver WA.
  6. Columbia Veterans Affairs Health Care System Columbia SC.
  7. Veterans Affairs Tennessee Valley Health System Murfreesboro TN.
  8. Academic Detailing Veterans Integrated Service Network 15 Kansas City MO.

PMID: 34796718 DOI: 10.1161/JAHA.121.022758

Abstract

Over the past decade, direct oral anticoagulants (DOACs) have contributed to a major paradigm shift in thrombosis management, replacing vitamin K antagonists as the most commonly prescribed anticoagulants in many countries. While DOACs provide distinct advantages over warfarin (eg, convenience, simplicity, and safety), they are frequently associated with inappropriate prescribing and adverse events. These events have prompted regulatory agencies to mandate oversight, which individual institutions may find difficult to comply with given limited resources. Veterans Health Administration (VHA) has leveraged technology to develop the DOAC Population Management Tool (PMT) to address these challenges. This tool has empowered VHA to update a 60-year standard of care from one-to-one provider-to-patient anticoagulation monitoring to a population-based management approach. The DOAC PMT allows for the oversight of all patients prescribed DOACs and leads to intervention only when clinically indicated. Using the DOAC PMT, facilities across VHA have maximized DOAC oversight while minimizing resource usage. Herein, we discuss how the DOAC PMT was conceived, developed, and implemented, along with the challenges encountered throughout the process. Additionally, we share the impact of the DOAC PMT across VHA, and the potential of this approach beyond anticoagulation and VHA.

Keywords: DOAC management; anticoagulant; anticoagulation; direct oral anticoagulant; population health; population management; veterans

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