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

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 Follow this and additional works at: http://scholarlyworks.lvhn.org/research-scholars-posters 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 This Poster is brought to you for free and open access by LVHN Scholarly Works It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator For more information, please contact LibraryServices@lvhn.org The Impact of Web Based Education on Attitudes and Outcomes in Patients Taking Warfarin Sarah Rupp, Kathryn Tadduni, Kay Werhun, DNP, MBA, RN, NE-BC, Valerie Rupp, MSN, RN, CRNP, Population Health Lehigh Valley Health Network, Allentown, Pennsylvania Methodology 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 naïve patents who 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 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 Monitoring Warfarin Module Objectives Module Managing Your Medications Module Module The Basics of Taking Warfarin What Can Affect Warfarin How To Stay Safe While Taking Warfarin Figure Patient Outcomes After Community Care Team Intervention Community Care Team Utilization Data: All Practices Months Pre & Post Intervention July 2012 through February 2015 4000 Number of Patient Encounters 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 nonadherence 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-naïve patients on their treatment in order to keep patients in a therapeutic INR range and reduce the risk of adverse events Module Introduction Figure Web-Based Education Modules 2000 1800 3500 1600 3000 1400 2500 1200 2000 1000 800 1500 600 1000 400 500 Pre-Engagement Post-Engagement Patient Count (Not Unique) 200 Admission 3731 1932 1730 Emergency 1400 1075 1022 Readmission 736 618 721 Figure Members of a Community Care Team Behavioral Health Specialist Nurse Care Manager Community Care Team Social Worker Pharmacist To determine the impact of a web-based educational application on patients who are warfarin naïve compared to warfarin naïve patients who 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 • Adverse events including :Gastrointestinal Bleed, Deep Vein 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 Conclusion 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 References • Center for Medicare and Medicaid Services (2015) Linking Quality to Payment • Foltz, C., Lawrence, S., Biery, N., Gratz, N., Paxton, H., & Swavely, D (2014) Supporting Primary Care Patient-Centered Medical Homes with Community Care Teams: Findings from a Pilot Study JCOM, 21(8) • Shull, J (2015) CCT Utilization Data: All Practices Lehigh Valley Health Network • Smith, D E., Xuereb, C B., Pattison, H M., Lip, G Y H., & Lane, D A (2010) TRial of an Educational 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 © 2014 Lehigh Valley Health Network ... 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... 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. .. team on patient outcomes Conclusion Both the web- based education and the CCT installment in the LVPG Anticoagulation Clinic aim to decrease overall hospital admissions and readmissions thereby