American College of Physicians: Internal Medicine — Doctors for Adults ®


Foundation update: one medical school is improving its anticoagulation care

From the July 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

Several years ago, the Brody School of Medicine of East Carolina University was looking for ways to reduce problems stemming from stroke-related atrial fibrillation and thromboembolism. Today, thanks in part to a $60,000 grant from the ACP-ASIM Foundation, the medical school is developing a program to better manage its anticoagulation patients and to identify at-risk patients who could benefit from specialized attention.

The Brody School of Medicine is located in Greenville, N.C., a rural area in the heart of the nation's "stroke belt." Roughly 80% of all counties in eastern North Carolina have stroke-related death rates greater than the national average of 58.9 out of 100,000, and Greenville is no exception.

In October 2000, the ACP-ASIM Foundation awarded East Carolina University a 12-month grant to tackle the problem head on. Since receiving the grant, project leaders including Carlos A. Estrada, FACP, assistant professor of medicine, have focused on the following four goals:

  • Establishing a disease management program that uses computerized tracking and reporting for patents on anticoagulant therapy;

  • Coordinating the care of anticoagulation therapy patients so they receive appropriate care and timely follow-up care;

  • Training health care providers in state-of-the-art anticoagulation management techniques; and

  • Identifying and combating literacy problems and their effects on patient compliance with anticoagulation therapies.

To accomplish those goals, project leaders have developed office procedures, eligibility criteria, care guidelines, warfarin dosage and other clinical protocols, referral guidelines and patient education materials. They have also created support systems for scheduling, communication and transportation to help patients adhere to care regimens and clinic appointments.

The project team has also created a template in its electronic medical record system to guide anticoagulation patient management. The template includes indications for anticoagulation, appropriate anticoagulation levels, expected duration of therapy and a bleeding risk index. Project members have also developed tracking and reporting systems to make sure that patients on anticoagulation therapy are receiving comprehensive care.

To identify individuals who might need a little more help keeping up with their therapy, the program is also assessing literacy and numeracy levels of its anticoagulation patient population. The program will provide university clinicians with an easy-to-use assessment tool to help them identify patients who need special assistance to comply with their anticoagulation therapy. (A list of anticoagulation resources can be found at

Finally, the university requires all residents to spend at least two full clinical days in the anticoagulation unit. Dr. Estrada also delivers lectures on anticoagulation management to practicing physicians, nurses and pharmacists.

The project is currently measuring the effectiveness of its efforts and their effect on patient health and is expected to report outcomes later this year.

For more information on the ACP-ASIM Foundation and the other grants it has funded, go to ACP-ASIM Online at


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