Volume 47 | Number 4 | August 2012

Abstract List

Adam J. Rose M.D., M.Sc., F.A.C.P., Beth Ann Petrakis, Patricia Callahan, Scott Mambourg, Dimple Patel, Elaine M. Hylek, Barbara G. Bokhour


Anticoagulation clinics (s) can improve anticoagulation control and prevent adverse events. However, s vary widely in their performance on anticoagulation control. Our objective was to compare the organization and management of top‐performing with that of bottom‐performing s.

Data Sources/Study Setting

Three high outlier and three low outlier s in the eterans ealth dministration ().

Study Design

Site visits with qualitative data collection and analysis.

Data Collection/Extraction Methods

We conducted semi‐structured interviews with staff regarding work flow, staffing, organization, and quality assurance efforts. We also observed operations and collected documents, such as the clinic protocol. We used grounded thematic analysis to examine site‐level factors associated with high and low outlier status.

Principal Findings

High outlier sites were characterized by (1) adequate (pharmacist) staffing and effective use of (nonpharmacist) support personnel; (2) innovation to standardize clinical practice around evidence‐based guidelines; (3) the presence of a quality champion for the ; (4) higher staff qualifications; (5) a climate of ongoing group learning; and (6) internal efforts to measure performance. Although high outliers had all of these features, no low outlier had more than two of them.


The top‐performing s in the system shared six relatively recognizable characteristics. Efforts to improve performance should focus on these domains.