Statewide stroke project achieves dramatic improvements in warfarin use

AF prevention collaborative helps patients, saves health care dollars

The atrial fibrillation (AF) team at HealthInsight, a nonprofit community quality improvement organization in Las Vegas, initiated a stroke prevention project that sought to increase the use of warfarin in eligible AF candidates in both inpatient and outpatient settings.

To accomplish the substantial improvements the team was aiming for, it decided to design the project as a statewide collaborative and obtain the cooperation of as many Nevada facilities as possible. The circle graphs accompanying this story (below) demonstrate the project’s accomplishments: statistically significant improvement in the percentage of eligible AF patients admitted or discharged on warfarin from 40.4% at baseline to 78.5% at remeasurement.

Kevin Kennedy, MHS, senior health care analyst at HealthInsight, says as with all of the quality improvement organization’s efforts, the focus of this project was on providers and health care organizations throughout the state of Nevada, where there is a total of 24 hospitals.

By gaining the support of physician leaders, the team was able to get the facilities to sign on.

"[We did it] mainly by acquiring what we called physician champions’ who promoted the project out in the community and within their own hospital setting," says Justine Bizette, RN, MSN, the project’s senior coordinator. "We called them champions,’ because if they supported the project, others in the community would follow.

"HealthInsight’s medical director, William Berliner, MD, was actively involved with our project team," says Bizette, "and he made presentations to hospitals and physician groups around the state."

Nine out of 24 hospitals participated, accounting for 80% of the AF discharges.

"Warfarin’s effect on stroke prevention is not a controversial topic, and a quality improvement department can take on a similar project and accomplish satisfying results," Bizette says. "Hospitals may want to alter the interventions to meet their own needs, but they can easily run a project like ours."