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 com-munity quality improvement organization in Las Vegas, initiated a stroke prevention project that sought to increase the use of war-farin in eligible AF candidates in both inpatient and outpatient settings. To accomplish the substantial improvements they were aiming for, the team decided that they would have to design their project as a statewide collaborative and obtain the cooperation of as many Nevada facilities as possible. The circle graphs accompanying this story (see p. 26)demonstrate the project’s accomplishments: statistically significant improvement in the percentage of eligible AF patients admitted or dis-charged on warfarin from 40.4% at baseline to 78.5% at re-measurement.
Kevin Kennedy, MHS, senior health care analyst at HealthInsight, says as with all of the quality improvement organization’s projects, the focus of this project was on providers and health care organizations throughout the state of Nevada, where there are a total of 24 hospitals.
By gaining the support of physician leaders, they were able to get the facilities to sign on.
"Mainly by acquiring what we called physician champions’ who pro-moted the project out in the community and within their own hospital setting," says Justine Bizette, RN, MSN, the pro-ject’s senior coordinator. "We called them cham-pions,’ 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 pre-sentations to hospitals and physician groups around the state."
Nine out of 24 hospitals participated, account-ing for 80% of the AF discharges.
Bizette says, "Warfarin’s effect on stroke pre-vention is not a controversial topic, and a quality improvement department can take on a similar project and accomplish satisfying results. Hospitals may want to alter the interventions to meet their own needs, but they can easily run a project like ours." HealthInsight also has offices in Reno, NV, and Salt Lake City, UT.
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