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## Complete Summary

#### TITLE

Anticoagulant medication management: percentage of patients with a
30-day supply (or more) of anticoagulants who had at least one blood
clotting test per each 45-day period.

#### SOURCE(S)

Katz A, DeCoster C, Bogdanovic B, Soodeen RA, Chateau D. Using
administrative data to develop indicators of quality in family practice.
Winnipeg, Manitoba: Manitoba Centre for Health Policy, University of
Manitoba; 2004 Mar. 87 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients with a 30-day
supply (or more) of anticoagulants (Coumadin or warfarin) who had at
least one blood clotting test per each 45-day period.

#### RATIONALE

Patients who are prescribed anticoagulants (Coumadin or warfarin) should
have regular blood testing to monitor the drug dosage. Inadequate drug
dosages will result in ineffective treatment while overdosage will place
the patient at risk for hemorrhage. This delicate balance requires
regular monitoring with a blood test known as an International
Normalized Ratio (INR).

#### PRIMARY CLINICAL COMPONENT

Anticoagulant medication; coumadin; warfarin; International Normalized
Ratio (INR)

#### DENOMINATOR DESCRIPTION

Patients assigned to a family physician with a 30-day (or more) supply
of anticoagulants (see the related \"Denominator Inclusions/Exclusions\"
field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Number of patients from the denominator who had at least one blood
clotting test per each 45-day period

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

-   Focus groups

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Overall poor quality for the performance measured\
Use of this measure to improve performance\
Variation in quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Katz A, DeCoster C, Bogdanovic B, Soodeen RA, Chateau D. Using
administrative data to develop indicators of quality in family practice.
Winnipeg, Manitoba: Manitoba Centre for Health Policy, University of
Manitoba; 2004 Mar. 87 p.

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement\
Quality of care research

### Application of Measure in its Current Use

#### CARE SETTING

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

The death rate for those with an increase of one unit of the
International Normalized Ratio (INR) above the recommended value (2.5)
doubled in one study.

#### EVIDENCE FOR BURDEN OF ILLNESS

Oden A, Fahlen M. Oral anticoagulation and risk of death: a medical
record linkage study. BMJ2002 Nov 9;325(7372):1073-5.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12424167)

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Safety

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients assigned to a family physician with a 30-day (or more) supply
of anticoagulants (see the \"Denominator Inclusions/Exclusions\" field)

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusion**\
Patients assigned\* to a family physician with a 30-day (or more) supply
of anticoagulants\*\*

\*A patient is allocated to the physician with the most visits (as
defined by cost). In the case of a tie, the patient is allocated to the
physician with the greatest total cost. Total cost calculations include
direct care (i.e., visits) and indirect care (i.e., referrals to other
physicians or for services such as lab tests and x-rays).

\*\*Coumadin or warfarin

**Exclusion**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients from the denominator who had at least one blood
clotting test per each 45-day period

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data\
Laboratory data\
Registry data

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

External comparison at a point in time

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Anticoagulation medication monitoring.

#### MEASURE COLLECTION

[Indicators of Quality in Family
Practice](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1814&doc=8426)

#### MEASURE SET NAME

[Acute & Chronic Disease
Management](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1814&doc=8428)

#### DEVELOPER

Manitoba Centre for Health Policy

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Unspecified

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Unspecified

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2004 Mar

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Katz A, DeCoster C, Bogdanovic B, Soodeen RA, Chateau D. Using
administrative data to develop indicators of quality in family practice.
Winnipeg, Manitoba: Manitoba Centre for Health Policy, University of
Manitoba; 2004 Mar. 87 p.

#### MEASURE AVAILABILITY

The individual measure, \"Anticoagulation Medication Monitoring,\" is
published in \"Using Administrative Data to Develop Indicators of
Quality in Family Practice.\" This document is available in Portable
Document Format (PDF) from the [Manitoba Centre for Health Policy Web
site](http://www.umanitoba.ca/centres/mchp/reports/pdfs/quality_wo.pdf).

For further information, contact: Manitoba Centre for Health Policy,
Department of Community Health Sciences, Faculty of Medicine, University
of Manitoba, 4th Floor, Room 408, 727 McDermot Ave, Winnipeg, Manitoba
R3E 3P5; telephone: (204) 789-3819; fax: (204) 789-3910; Web site:
[www.umanitoba.ca/centres/mchp](http://www.umanitoba.ca/centres/mchp/).

#### NQMC STATUS

This NQMC summary was completed by ECRI on April 18, 2006. The
information was verified by the measure developer on May 1, 2006.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008