John M. Eisenberg Patient Safety Awards. Safety, effectiveness, and efficiency: a Web-based virtual anticoagulation clinic.

BACKGROUND Information systems that include Web-based technology can provide clinical decision support in care processes that can be algorithmically described. Long-term oral anticoagulation with warfarin is one such care process. THE VIRTUAL ANTICOAGULATION CLINIC: A clinical decision support tool was developed using evidence-based guidelines from the extant medical literature on the indications for and management of therapy with warfarin. Training modules for physicians and support staff were implemented, and patients were prospectively enrolled in the "virtual anticoagulation clinic" when they began taking warfarin or when they returned for routine follow-up under the usual care model. Designated warfarin coordinators managed the virtual anticoagulation clinic under physician supervision. RESULTS Following the adoption of the virtual anticoagulation clinic, uniform improvement in time in therapeutic range was observed in each participating practice, with those practices using it the longest equaling or exceeding results reported from formally organized warfarin clinics. Major adverse events were observed only in patients who were not managed in the manner suggested by the virtual anticoagulation clinic. CONCLUSIONS A Web-based solution to chronic anticoagulation therapy offers an inexpensive, safe, and significantly more effective alternative to the usual care model.