Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Abstract

<jats:p> Appropriate perioperative management of patients on chronic oral anticoagulation (OAC)—including warfarin and the direct oral anticoagulants—is a poorly defined yet important clinical issue with potentially severe consequences in the postoperative period. We sought to prospectively evaluate the effect of the Management of Anticoagulation in the Periprocedural Period (MAPPP) mobile app as a clinical decision tool in the management of patients on chronic OAC undergoing elective procedures or surgeries. Between January 1, 2018, and January 31, 2019, 642 patients treated in our health system were included. Eligible patients met the following criteria: age &gt;18 years old, creatinine clearance ≥15 mL/min, and on chronic OAC with adequate information regarding baseline characteristics. Our study outcome was patient’s emergency department (ED) visits within 30 days postprocedure. The MAPPP app was integrated into the electronic health record (EHR), and the end user was free to accept or decline recommended evidence-based perioperative anticoagulation management guidance. Analysis revealed that acceptance was more common in younger patients ( P = .0137), patients on oral anticoagulants other than warfarin ( P &lt; .0001), and patients undergoing increased bleeding risk procedures ( P = .0068). Acceptance of the MAPPP app recommendation was significantly associated with fewer ED visits (acceptance group: 4.0% vs rejection group: 8.3%, P = .0205). Logistic regression showed that intervention acceptance and female gender were significantly associated with fewer—while age ≥80 with more—30-day ED visits. Our findings indicate that newer technologies, such as the MAPPP app, integrated into clinical EHR workflow, can significantly augment evidence-based perioperative anticoagulation management and potentially result in a reduction of adverse outcomes. </jats:p>

Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review

“…The study revealed that physicians are more likely to follow the guidelines provided by the app with younger patients with normal renal function and who are taking DOAC medication, whereas they tend to trust their clinical expertise and deviate from the guidelines with older patients with impaired renal function and who are receiving warfarin therapy. The study showed a significantly lower rate of admissions to the emergency department for the cohort in which health practitioners accepted the app’s advice than in the cohort where the advice was rejected (4.0% vs 8.3%; P =.02) [ 37 ].…”

Implementation of the Management of Anticoagulation in the Periprocedural Period App into an Electronic Health Record: A Cost-Effectiveness Analysis

“…An SF-12 survey was sent to eligible patients who had previously participated in our prospective cohort regarding the effectiveness of the MAPPP app. 6 The study was approved by the health system Institutional Review Board (IRB#:18-0948) overseeing all hospitals and healthcare facilities visited by the patients and was conducted in accordance with principles of the Declaration of Helsinki. Informed consent forms were given to all patients who were invited to complete the survey.…”

“… 8 – 10 The participants were separated into two groups depending on whether their healthcare providers had previously decided to accept the app's treatment recommendations (acceptance group) or not (rejection group), based on the patient cohorts previously defined. 6 The total number of 30-day hospital readmissions of the responders was used to calculate the related costs for each group. These costs and the resulting quality-of-life (QOL) data were used to calculate the incremental cost-effectiveness ratio (ICER).…”

“…4 MAPPP has previously been studied for its uptake and utilization by health care providers 5 and was proven to be effective in the reduction of 30-day readmissions and deaths. 6 The positive outcomes of the MAPPP app gave ground for a further analysis of its effects on cost reduction as well as cost-effectiveness in this group of patients.…”

Securing administrative leadership commitment for anticoagulation stewardship programs

“…40,41 In preparing for these discussions, it may be helpful to collect examples of successful initiatives from other institutions, particularly from those that utilize the same EHR. [42][43][44] These examples may come from published medical literature (perhaps previously collected in Section 2.3 above), EHR vendor-based libraries, or direct correspondence with staff at other institutions. While IT services may be perceived as barriers to implementation, this preparation can enhance collaboration and even reduce the implementation budget by providing explicit guidance for the design and construction of EHR tools.…”