Michigan Anticoagulation Quality Improvement Initiative (MAQI2) is a multi-center, collaborative quality improvement registry of anticoagulation care sponsored by Blue Cross Blue Shield of Michigan. Data is collected on patients receiving warfarin management in the outpatient setting at 6 participating Michigan sites and entered into a data registry at the MAQI2 Coordinating Center located within MCORRP. Data collected include patient demographics, medications, co-morbidities, time in therapeutic range (TTR), and frequency of adverse events. Information on each site’s protocols, processes, and structure is also collected in an effort to link outcomes with variations in clinic operations. Over 12,000 patients have been entered into the registry along with over 380,000 follow-ups.
Opportunities for improvement have been identified, best practices have been shared between sites, and interventions are underway. These quality improvement projects include: reducing the inappropriate use of warfarin, developing more effective patient education materials, performing regular root-cause-analyses of adverse events, and reducing unnecessary lab testing. In addition, the MAQI2 collaborative has developed the MAQI2 Anticoagulation Toolkit, which includes a downloadable collection of guidelines, protocols, and a mobile app to help providers manage anticoagulation patients more safely and effectively. The toolkit also includes patient education resources in multiple languages for patients to learn more about how to take anticoagulants safely. Information for the toolkit and mobile app can be found at: www.anticoagulationtoolkit.org. Thousands of providers and patients across the country are using the toolkit to improve anticoagulation safety and effectiveness.
Beginning in 2016, MAQI2 began studying patients starting one of the new classes of anticoagulants, direct oral anticoagulants (DOACs). These newer anticoagulants are thought to be easier to manage than warfarin and were found to be safer in clinical trials. However, it is not known if providers will prescribe DOACs appropriately or if patients will be monitored adequately in the real-world. There will likely be opportunities for improvement in agent selection, proper dosing, and patient monitoring.
Brian Haymart, RN, MSN
Tina Alexandris-Souphis, RN, BSN, BS
MAQI Coordinating Center
University of Michigan Health System
Jim Froehlich MD, MPH
Geoff Barnes MD, Research Fellow
William Beaumont Hospital
Steven Almany, MD
Michigan Heart Group
Cardiology and Vascular Associates/ Huron Valley Sinai
Jay Kozlowski, MD, FACC
Henry Ford Hospital and Medical Center
Vinay Shah, MD; FACP
Greg Krol, M.D.
Thomas Teal, MD
West Michigan Heart — a member of Spectrum Health
Michael McNamara, MD
Musa Daho, MD
Scott Kaatz, DO, MSc, FACP