Outpatient management of warfarin therapy: comparison of computer-predicted dosage adjustment to skilled professional care

• HIT Description: Computer drug dosing system. More info...
  
• Purpose of Study: Compare warfarin dosage-adjustments using a computer program to dosage-adjustments by a nurse-specialist.
  
• Years of study: Not Available
  
• Study Design: RCT
  
• Outcomes: Impact on health care effectivness/quality, Impact on efficiency, utilization, costs
  

• Settings: The study was conducted at the Anticoagulation Clinic at the U C Davis Medical Center, Sacramento, California, and included 50 patients who were receiving chronic warfarin therapy and who required a dosage adjustment.
• Intervention:  The accuracy of warfarin dosage-adjustments predictions using a computer program was compared to the accuracy of an experienced anticoagulation nurse-specialist.
• Evaluation Method: Measures of accuracy of warfarin dosage adjustments, and final prothrombin time within 2 s.
• Description: The computer program (ÒDrug CalcÓ) predicted the steady state warfarin dose by applying Bayesian forecasting techniques to a mathematical model of the dynamic pharmacologic response to warfarin.
• Quality of Care and Patient Safety Outcome: There was no significant difference between the computer program and the anticoagulation nurse-specialist and the mean of the absolute value of the differences between final prothrombin times and target prothrombin times, nor was there a difference in the proportion of patients who had a final prothrombin time within 2 s of the target prothrombin time.