Anticoagulation management is a data-driven, communication-intensive process. Patients with newly placed Ventricular Assistance Devices (VADs) require anticoagulation management and are at high risk for readmissions.
We partnered with a team of nurses from the Penn Medicine Heart and Vascular Center to explore the impact of home international normalized ratio (INR) testing for post-discharge anticoagulation management as well as electronic collection of contextual information required for anticoagulation management.
The team hypothesized that home INR testing would reduce barriers to access, decrease missed or delayed tests, enable providers to prescribe more frequent testing as needed, shorten turnaround time to receive results, and improve patient satisfaction.
To test these hypotheses, we distributed home INR kits to six new VAD patients for 90-days post-discharge and compared their experience to ten non-enrolled VAD patients.
We saw early signs of value through the pilot, gathering enough evidence to support further testing of our hypotheses. The 30-day readmission rate decreased from 50% among non-enrolled patients to 17% among enrolled patients. The 90-day readmission rate decreased from 140% among non-enrolled patients to 33% among enrolled patients. The 90-day mortality rate decreased from 20% among non-enrolled patients to 0% among enrolled patients. We also saw faster provider response and fewer consecutive days below range for enrolled patients.