Development of the Direct Oral Anticoagulants Dashboard for Pharmacists to Optimize Care for Veterans

ANJU SAHAY, PhD
Veterans Affairs Palo Alto Health Care System

The focus of the Department of Veteran Affairs’ (VA) Medication Safety (MedSafe) QUERI Program is to reduce potentially unsafe or unnecessary medications for Veterans. We conducted the national evaluation on the utilization of the VA Office of Pharmacy Benefits Management (PBM) Service’s Center for Medication Safety (VAMedSAFE) Web application called the Medication Use Evaluation Tracker (MUET). On a monthly/quarterly basis this application identifies at-risk Veterans across all VA sites.
 
Our national evaluation confirmed interest in PBM/VAMedSAFE development of national medication safety and appropriate use of dashboards to identify and reduce potentially unsafe medication utilization. The Direct Oral Anticoagulant (DOAC) patient management tool was developed as a facility/VISN initiative and was evaluated as a candidate for national use based on the occurrence of adverse events and risk of therapeutic failures related to DOAC therapy. VAMedSAFE validated and optimized the report with the developer, and in conjunction with our MedSafe QUERI Program the DOAC Dashboard became the first national medication safety dashboard.

Development of five national dashboards.

In September 2017 in conjunction with PBM, the MedSafe QUERI Program invited subject matter experts, VISN (Regional) Pharmacy Executives and other key stakeholders to form the PBM VAMedSAFE National Medication Safety Dashboard Advisory Committee. The role of this Committee has been to coordinate and approve dashboard solutions that relate to VAMedSAFE national projects and initiatives. This Committee meets on a quarterly basis and has prioritized the development or adoption of five National Dashboards as mediation safety/appropriate use population health management tools. These dashboards are designed to identify at-risk Veterans across all the VA sites with regular data updates and daily accessibility to clinicians.

In July 2019, the DOAC Dashboard was made available at all 146 VA sites (18 VISNs) for the monitoring of all patients prescribed DOAC therapy. By December 2020, the DOAC Dashboard use has been documented at 122 (84%) sites where staff at these sites have utilized the DOAC Dashboard to complete at least one write-back (an administrative marker for the use of this Dashboard).
 
At these 122 (84%) sites, a total of 1,500 staff have previously and/or currently use the DOAC Dashboard. In contrast, as yet no write-back has been received from the remaining 24 (16%) sites. This Dashboard has already served a total of 173,918 Veterans.
 
The remaining four dashboards at various stages of development are: Proton Pump Inhibitors Dashboard, AntiCD20 Antibody Dashboard, Direct-Acting Antivirals-Hepatitis B Monitoring/Re-activation Dashboard andAzathioprine/6-Mercaptopurine Dashboard.

As a population health management tool, the DOAC Dashboard provides oversight for the monitoring of treatment for DOACs.