Many best practices have been described for organizing a clinic to manage warfarin. Although these practices may have face validity, they may not be based on empirical analysis. Here, we describe our decade-long effort to apply the Structure-Process-Outcome model of quality measurement as a basis for measuring and improving outpatient warfarin management in the Veterans Health Administration. The purpose of the article is to raise awareness of this body of work with pharmacists who could potentially incorporate the findings of this work into their own practice settings. We conclude with concrete suggestions for immediate implementation in clinical settings.
To review the article: http://journals.sagepub.com/doi/abs/10.1177/1060028018782473?journalCode=aopd
Adam Rose is a physician policy researcher at the RAND Corporation, focusing on improving prescribing and measuring quality of care. From 2008-2016, he served as an investigator at the VA Center for Healthcare Organization and Implementation Research, and from 2013-2016 he led their Medication Optimization Program. His largest research effort, spanning almost a decade, has been focused on improving the management of oral anticoagulants. The performance measures developed by Dr. Rose and his colleagues for anticoagulation are now used across the entire VA system. Dr. Rose received his M.D. from the University of Pennsylvania.