Virginia Mason Medical Center

Virginia Mason Medical Center decreases stroke incidence by 70% through implementing a quality program.

Situation

Anticoagulation therapy is used when the heart tends to beat out of rhythm --a condition known as atrial fibrillation. Patients with this condition are at an increased risk of stroke but can decrease their risk by taking Warfarin Sodium (popular name is Coumadin.) which thins the blood. However, Coumadin must be carefully regulated. After completing an institutional chart review, Virginia Mason Medical Center found that this treatment was association with a high rate of adverse drug reactions—either major bleeding (blood too thin) or stroke (caused by blood clotting).

Solution

Virginia Mason Medical Center established the Comprehensive Anticoagulation Clinic Program. Over a 10-year period, the medical group has implemented a series of initiatives. Their aim was to standardize as many common practices as possible. Using a phased approach, the Center was able to standardize such practices as patient, physician, and staff education; therapy initiation and monitoring; clinical outcomes measurement; and care delivery. The program also features many innovative care approaches such as the creation of a Web-based “Manual of Oral Anticoagulation Therapy.” This Web-based “manual” provides referring physicians and all medical center staff with evidence-based summaries of treatment, complications, perioperative, and drug interaction algorithms, as well as updated outcomes data.

Better Health & Lower Costs

Since the implementation of the Comprehensive Anticoagulation Clinic Program, The Virginia Mason Medical Center has been able to decrease the incidence of stroke by 70% and the incidence of major bleeding by 72% in patients participating in the program. The baseline of major bleeding went from an annual incidence rate of 5% to 1.4% and the baseline for stoke fell from a 3% annual incidence rate to a 0.9% rate. Given the decrease in incidence rates and the number of individuals enrolled in the program, we can extrapolate that 112 major bleeding incidents and 65 strokes were prevented through this program. The American Medical Group Association and Pfizer, Inc. awarded the Virginia Mason Medical Center their Models of Excellence in High-Risk Patient Management Award with a $50,000 grant because of their outstanding results.