Out‐of‐range INR results lead to increased health‐care utilization in four large anticoagulation clinics

• DOI: 10.1002/rth2.12110
• Publication Date: 2018-05-28T02:43:51Z
• Authors: Geoffrey D Barnes; Xiaokui Gu; Eva Kline‐Rogers; Christopher Graves; Eric Puroll; Kevin Townsend; Ellen McMahon; Terri Craig; James B Froehlich
• Keywords: warfarin; 03 medical and health sciences; 0302 clinical medicine; pharmacist; delivery of health care; Health Sciences; Hematology and Oncology; health services; costs and cost analysis; Original Articles: Thrombosis; 3. Good health

The impact on health-care costs and utilization of a single out-of-range (OOR) INR value not associated with bleeding or thromboembolic complication among chronic warfarin-treated patients is well described.At four large phone-based anticoagulation clinics (total 14 948 patients), atrial fibrillation (AF) venous thromboembolism were retrospectively propensity matched into an OOR group (n = 116) control 58). Types frequency contacts (eg, phone, voicemail, facsimile) personnel involved identified. A prospective time study analysis 59 92 was performed over 8.5 days to record the required care for these patients. 2016 USD cost estimates generated from average salaries.OOR in-range experienced 4.2 3.2 (P < .001) lab draws until two sequential tests in range. 5.3 interactions clinic vs 3.7 .001). more often phone calls, fewer mailed letters, multiple types contact than In analysis, total median each 5.1 minutes (IQR 3.7-9.5) 2.9 1.8-5.8) values At level, yearly staff $17 938 $8969-$31 391).We quantified amount extra effort manage who experience without complications, which leads higher healthcare costs.