Stroke Prevention/ Treatment

Stroke Prevention/Treatment From 1996-1999, QIOs in 22 states developed projects focused on increasing warfarin use in patients with atrial fibrillation who demonstrated appropriate clinical indications. A number of these projects also looked at whether patients discharged on warfarin received proper education about their condition and medication. Some of the projects also evaluated the percent of atrial fibrillation patients taking warfarin who maintain an international normalized ratio (INR) between 2.0 and 3.0, which indicates that their warfarin therapy is being properly managed. All of the projects attempting to increase the percentage of appropriate patients receiving warfarin reported a positive impact, with a median increase of 23%. All projects that sought to boost the percentage of patients discharged on warfarin who received appropriate education were successful, with a median gain of 120%. Finally, all of the projects seeking to improve the percentage taking warfarin that maintain an INR between 2.0 and 3.0 also showed gains, with a median increase of 20%. Some examples: Lumetra estimates that its success in increasing use of warfarin—from 48% to 52% of eligible patients—translated into the prevention of an estimated 70 strokes and savings of roughly $2.6 million a year in medical costs alone in California. Louisiana Health Care Review, Inc. worked with 17 local organizations to improve care for patients suffering from stroke or stroke-like symptoms who present to acute care facilities. The project resulted in a significant reduction in the use of fast-acting nifedipine, from 32% of patients to 4%. The study also showed a moderate increase in the percent of patients treated with three or more blood pressure measurements and in the percent receiving a CT or MRI scan within two hours. Healthcare Quality Strategies, Inc., the New Jersey QIO, in conjunction with 29 New Jersey hospitals, increased the number of Medicare patients with atrial fibrillation discharged on warfarin from 58% to 69%. This project, which combined process changes and a new Fast Track methodology, produced positive benefits for more than 14,000 of New Jersey’s older adults with atrial fibrillation. The Fast Track methodology combines monthly visits with continuous interim data feedback.

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