The DOI matches its Crossref record; 46 of the 48 references it cites were found in a registry or an index.
Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial
Abstract
Randomized trials have indicated that well-managed anticoagulation with warfarin could prevent more than half of the strokes related to atrial fibrillation. However, many patients with atrial fibrillation who are eligible for this therapy either do not receive it or are not maintained within an optimal prothrombin time-international normalized ratio (INR) range. We sought to determine whether an anticoagulation service within a managed care organization would be a feasible alternative for providing anticoagulation care. We performed a multi-site randomized trial in six large managed care organizations in the United States. Subjects were aged 65 years or older and had nonvalvular atrial fibrillation. At each site, physician practices were divided into two geographically defined practice clusters; each site was randomly assigned to have one intervention and one control cluster. The intervention cluster received an anticoagulation service that satisfied specifications for high-quality anticoagulation care and was coordinated through the managed care organization. Control clusters continued with their usual provider-based care. We measured the proportion of time that warfarin-treated patients in each of the clusters (intervention and control) were in the target range for the INR at baseline, and again during a follow-up period. Five of the six selected sites succeeded at developing an anticoagulation service. Patients in the intervention and control clusters had similar demographic characteristics, contraindications to warfarin, and risk factors for stroke. Among patients (n = 144 in the intervention clusters; n = 118 in the control clusters) for whom data were available during the baseline and follow-up periods, the changes in percentages of time in the target range were similar for those in the intervention clusters (baseline: 47.7%; follow-up: 55.6%) and in the control clusters (baseline: 49.1%; follow-up: 52.3%; intervention effect: 5%; 95% confidence interval: -5% to 14%; P = 0.32). Although it was feasible in a managed care organization to implement anticoagulation services that were tailored to local circumstances, provision of this service did not improve anticoagulation care compared with usual care. The effect of the anticoagulation service was limited by the utilization of the service, the degree to which the referring physician supports strict adherence to recommended target ranges for the INR, and the ability of the anticoagulation service to identify and to respond to out-of-range values promptly.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Other bias Unclear risk Contamination may have been possible, since geographically related practices were randomised to intervention and control groups. Patient characteristics were similar in both groups”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Selective reporting (reporting bias) Low risk Appropriate outcomes reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Risk of bias overall High risk 5 unclear risk criteria, including allocation concealment”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Random sequence generation (selection bias) Low risk A computer random number function was used”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Allocation concealment (selection bias) Unclear risk Process not reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Blinding of outcome assessment (detection bias) All outcomes Unclear risk Whether or not the data abstractors were blinded is not reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Baseline characteristics Unclear risk There were no differences in patient characteristics between study groups. No data on clinicians”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Contamination Low risk Groups of geographically related practices were randomised”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Baseline outcomes Low risk No differences at baseline”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“Incomplete outcome data (attrition bias) All outcomes High risk 30% attrition is reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
Citations
Cites
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,417
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,421
Atrial fibrillation as an independent risk factor for stroke: the Framingham study
Wolf, P. A., Abbott, R. D., & Kannel, W. B. (1991) · Stroke · doi:10.1161/01.str.22.8.983 · Cited by 7,388
Risk Factors for Stroke and Efficacy of Antithrombotic Therapy in Atrial Fibrillation
(1994) · Archives of Internal Medicine · doi:10.1001/archinte.154.13.1449 · Cited by 2,643
Statistical Power Analysis for the Behavioral Sciences
(1977) · doi:10.1016/c2013-0-10517-x · Cited by 2,457
A Method to Determine the Optimal Intensity of Oral Anticoagulant Therapy
Rosendaal, F. R., Cannegieter, S. C., van der Meer, F. J. M., & Briët, E. (1993) · Thrombosis and Haemostasis · doi:10.1055/s-0038-1651587 · Cited by 2,070
EAFT (European Atrial Fibrillation Trial) Study Group (1993) · The Lancet · doi:10.1016/0140-6736(93)92358-z · Cited by 1,877
Petersen, P., GODTFREDSEN, J., Boysen, G., Andersen, E. D., & Andersen, B. (1989) · The Lancet · doi:10.1016/s0140-6736(89)91200-2 · Cited by 1,814
Oral Anticoagulants: Mechanism of Action, Clinical Effectiveness, and Optimal Therapeutic Range
Hirsh, J., Dalen, J. E., Anderson, D. R., Poller, L., Bussey, H. I., Ansell, J., & Deykin, D. (2001) · CHEST Journal · doi:10.1378/chest.119.1_suppl.8s · Cited by 1,813
Stroke Prevention in Atrial Fibrillation Study. Final results.
Prevention, S., & Atrial Fibrillation Investigators (1991) · Circulation · doi:10.1161/01.cir.84.2.527 · Cited by 1,696
Research works printed but not linked: 1
- Samsa, 1998, A seven-step model for practice improvement research, New Med, 2, 139
Cited by
Sorted by citations
Pharmacology and Management of the Vitamin K Antagonists
Ansell, J., Hirsh, J., Hylek, E. M., Jacobson, A. K., Crowther, M. A., & Palareti, G. (2008) · CHEST Journal · doi:10.1378/chest.08-0670 · Cited by 2,135
“The study by Matchar et al 287 also failed to show a significant improvement in TTR between the two models of care, although the AMS performed modestly better than UC.”
ResultIncidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting
Gurwitz, J. H., Field, T. S., Harrold, L. R., Rothschild, J. M., DeBellis, K. R., Seger, A. C., Cadoret, C. A., Fish, L. S., Garber, L., Kelleher, M., et al. (2003) · JAMA · doi:10.1001/jama.289.9.1107 · Cited by 1,666
“While more widespread use of specialized clinics for anticoagulation therapy to provide coordinated care has been promoted to improve the effectiveness and safety of warfarin in elderly patients,(30) to date the benefits of this approach relative to usual care have not been established.(31) While most antibiotic-assoc…”
BackgroundThe Pharmacology and Management of the Vitamin K Antagonists
Ansell, J., Hirsh, J., Poller, L., Bussey, H. I., Jacobson, A. K., & Hylek, E. M. (2004) · CHEST Journal · doi:10.1378/chest.126.3_suppl.204s · Cited by 1,530
Ageno, W., Gallus, A. S., Wittkowsky, A. K., Crowther, M. A., Hylek, E. M., & Palareti, G. (2012) · CHEST Journal · doi:10.1378/chest.11-2292 · Cited by 1,583
Evidence-Based Management of Anticoagulant Therapy
Holbrook, A. M., Schulman, S., Witt, D. M., Vandvik, P. O., Fish, J., Kovacs, M. J., Svensson, P. J., Veenstra, D. L., Crowther, M. A., & Guyatt, G. H. (2012) · CHEST Journal · doi:10.1378/chest.11-2295 · Cited by 1,292
Metadata
- Authors
- Matchar, D. B., Samsa, G. P., Cohen, S. J., Oddone, E. Z., & Jurgelski, A. E.
- Affiliations
- Duke University (US)
- University of Arizona (US)
- Corresponding author
- Matchar, David B
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2002-07
- Volume
- 113
- Issue
- 1
- Pages
- 42-51
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2063025825
- Cited by
- 141
- References
- 48
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 7 · 2016: 4 · 2015: 7 · 2014: 10 · 2013: 7 · 2012: 13
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, anticoagulation management, warfarin, INR control, managed care organizations, anticoagulation service, stroke prevention, non-valvular atrial fibrillation, older adults, quality of care, implementation feasibility, time in therapeutic range, usual care comparison
- MeSH terms
- Aged, Anticoagulants, Atrial Fibrillation, Female, Health Maintenance Organizations, Humans, Male, Managed Care Programs, Prothrombin Time, Quality of Health Care, Risk Factors, United States, Warfarin, International Normalized Ratio, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
