The overall goal is to improve outcomes among patients with atrial fibrillation (AF) by preventing stroke. The investigators propose to implement an automated algorithm using electronic medical record (EMR) data to alert physicians in a large primary care practice network at the Massachusetts General Hospital (MGH) of their patients with AF and elevated stroke risk that are not taking an anticoagulant for stroke prevention. The investigators hypothesize that interventions to notify physicians of such individuals may prompt reassessment for the need for anticoagulation, and thereby increase guideline-indicated anticoagulation rates. Additionally, in a survey component, physicians will characterize reasons for not pursuing anticoagulation in AF patients at elevated risk for stroke.
The overall goal is to improve outcomes among patients with atrial fibrillation (AF) by preventing stroke. The investigators propose to implement an automated algorithm using electronic medical record (EMR) data to alert physicians in a large primary care practice network at the Massachusetts General Hospital (MGH) of their patients with AF and elevated stroke risk that are not taking an anticoagulant for stroke prevention. Using a medical record algorithm, there are an estimated 2,000 to 3,000 such patients in the primary care practices at MGH. The investigators hypothesize that interventions to notify physicians of such individuals may prompt reassessment for the need for anticoagulation, and thereby increase guideline-indicated anticoagulation rates. The investigators define the following three Specific Aims to address the primary study hypothesis: Specific Aim 1: Implement an automated alerting system within the EMR to notify primary care physicians (PCPs) of patients with AF at elevated stroke risk that are not being treated with anticoagulants. To maximize efficiency of the effort, the alert will not require a concurrent clinic visit, but rather will occur with existing data aggregated from the medical record independent of any clinical encounter. Specific Aim 2: Test whether the alerting system increases the rate of anticoagulation at 3 months after implementation. Specific Aim 3: Characterize the reasons for not pursuing anticoagulation in AF patients at elevated risk for stroke. Specific Aim 4: Assess how PCPs want to be alerted about anticoagulation status in the future and what types of support they find helpful
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
2,336
PCP notification at baseline that patient has atrial fibrillation, high stroke risk, and is not anticoagulated.
Massachusetts General Hospital
Boston, Massachusetts, United States
Proportion of patients taking an anticoagulant
Difference in the proportion of patients with AF at high risk of stroke taking an anticoagulant at 3-months in the baseline alert arm , compared to the proportion taking an anticoagulant at 3-months in the 3-month alert arm
Time frame: 3-months
Proportion of patients taking direct oral anticoagulants vs. warfarin
Difference in the proportion of patients with AF at high risk of stroke taking an anticoagulant at 3-months in the baseline alert arm , compared to the proportion taking an anticoagulant at 3-months in the 3-month alert arm, stratified by type of anticoagulant (direct oral anticoagulants vs. warfarin)
Time frame: 3-months
Reasons for not prescribing an anticoagulant
Documented reasons for not prescribing an anticoagulant
Time frame: 3-months
Physician characteristics derived from the questionnaire and hospital databases that are associated with having a low proportion of the physician's panel of atrial fibrillation patients on oral anticoagulants
Physician-level characteristics associated with having anticoagulation rates of the physician's panel of atrial fibrillation patients in the lowest quartile among all eligible physicians.
Time frame: 3-months
Patient-level characteristics derived from the questionnaire and the electronic health record that are associated with not being prescribed an anticoagulant
Patient-level characteristics that may influence decision making for a physician to not prescribe an anticoagulant
Time frame: 3-months
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