The Impact of Web Based Education on Attitudes and Outcomes in Pa

Lehigh Valley Health NetworkLVHN Scholarly Works Research Scholars Poster Presentation The Impact of Web Based Education on Attitudes and Outcomes in Patients Taking Warfarin Sarah Rupp

Lehigh Valley Health Network

LVHN Scholarly Works

Research Scholars Poster Presentation

The Impact of Web Based Education on Attitudes and Outcomes in Patients Taking Warfarin

Sarah Rupp

Rollins College

Kathryn Tadduni

Unversity of Pittsburgh

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Published In/Presented At

Rupp, S.; Tadduni, K., (2015, July 31) The Impact of Web Based Education on Attitudes and Outcomes in Patients Taking Watfarin Poster

presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.

© 2014 Lehigh Valley Health Network

Lehigh Valley Health Network, Allentown, Pennsylvania

The Impact of Web Based Education on Attitudes and Outcomes in Patients Taking Warfarin

Patients taking warfarin are at risk for thromboembolic

events when not in a therapeutic international normalized

ratio (INR) range Patient’s lack of understanding

regarding their medication and illness often leads to

non-adherence to medication, which can lead to adverse

events In a retrospective cohort study, the Lehigh Valley

Physicians Group (LVPG) Anticoagulation Clinic will be

able to analyze the impact of implementing a web-based

educational application that can be accessed from the

patient’s home The objective is to educate warfarin-nạve

patients on their treatment in order to keep patients in a

therapeutic INR range and reduce the risk of adverse

events

To determine the impact of a web-based educational application on patients who are warfarin nạve compared to warfarin nạve patients who do not take part in the web based education

Outcomes captured and measured will include:

• Percent time patients remain in a therapeutic International

Normalized Ratio (INR) Range

Thrombosis (DVT), Pulmonary Embolism (PE), Myocardial Infarction (MI), and Number of hospitalizations and readmissions

• illness effects on Quality of Life (QoL) including the physical,

psychological, emotional, and spiritual impact

• Anxiety and Depression scores

• Patients knowledge and understanding of warfarin

• Patients Knowledge and understanding of their illness

The CHF cohort will be measured separately to determine the impact

of the community care team on patient outcomes

In a retrospective cohort study, Lehigh Valley Physicians Group (LVPG)

Anticoagulation Clinic will provide access to web-based education to patients

requiring first time treatment with the oral anticoagulant, warfarin These

patients will be followed for one year to capture % time in therapeutic range

and the frequency of adverse events such as stroke, gastrointestinal bleed,

deep vein thrombosis (DVT), pulmonary embolus (PE), myocardial infarction

(MI), hospital re-admissions, and hospitalizations Patient outcomes in the

study group will be compared to outcomes in warfarin nạve patents who do

not take part in the web-based education

Secondary outcomes will include patients’ perception on their quality of life,

severity of anxiety and depression, their knowledge regarding understanding

of their illness and medication prior to and after education Surveys will be

captured at baseline and six months Surveys include the Palliative Outcome

Scale (POS), to measure quality of life, Patient Health Questionnaire (PHQ-9)

to assess their depression score, Generalized Anxiety Disorder 7 Item Scale

(GAD-7) to assess their anxiety score, and Patient Activation Measure

(PAM) which will measure the patient’s knowledge and perception of both

their medication and illness

A community care team (CCT) will be joining LVPG Cardiology to assist with

the management of patients with Congestive Heart Failure (CHF).Team

members will be consulted when patients are identified in the study as having

anxiety, depression, poor coping skills, a poor understanding of their warfarin

medication, financial issues, or lack of social support at home These patient

outcomes will be analyzed separately to determine effectiveness of the CCT

on this patient population

Both the web-based education and the CCT installment

in the LVPG Anticoagulation Clinic aim to decrease overall hospital admissions and readmissions thereby cutting costs and satisfying the requirements for the Hospital Readmission Reduction Program under the Affordable Care Act With the objective of decreasing adverse events, keeping patients in a therapeutic INR range, and encouraging patients to be proactive and knowledgeable in regards to their treatment, both the web-based education and CCT have the intention of

achieving the three goals specified by the Triple Aim;

better cost, better health, and better care

Sarah Rupp, Kathryn Tadduni, Kay Werhun, DNP, MBA, RN, NE-BC, Valerie Rupp, MSN, RN, CRNP, Population Health

Introduction

Methodology

Objectives

Conclusion

Community Care Team

Behavioral Health

Specialist

Pharmacist

Social Worker

Nurse Care Manager

1

The Basics

of Taking Warfarin Module

Managing

Your Medications Module

Monitoring Warfarin Module

What Can Affect Warfarin Module

How To Stay Safe While Taking Warfarin

Admission Emergency Readmission Pre-Engagement 3731 1400 736 Post-Engagement 1932 1075 618 Patient Count (Not Unique) 1730 1022 721

0 200 400 600 800 1000 1200 1400 1600 1800 2000

0 500 1000 1500 2000 2500 3000 3500 4000

Community Care Team Utilization Data: All Practices

6 Months Pre & Post Intervention July 2012 through February 2015

Figure 1 Web-Based Education Modules

Figure 2 Patient Outcomes After Community Care Team Intervention

Figure 3 Members of a Community Care Team

References

Patient-Centered Medical Homes with Community Care Teams: Findings from a Pilot Study JCOM,

21(8)

intervention on patients’ knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and

outcome of Treatment with warfarin (TREAT) BMC Cardiovascular Disorders, 10(1), 21