Coronary disease & ACSCohort study
Multilevel Stewardship Intervention for Use of Anticoagulation-Antiplatelet Therapy
- quality improvement study
- retrospective multiperiod comparative interrupted-time-series analysis
- 7 Veterans Health Administration (VHA) health systems as intervention sites, 128 other VHA health systems as controls
- July 2020 to July 2023
Authors' conclusion
This study found that the combined interventions were associated with a clinically meaningful reduction in potentially harmful combination antithrombotic therapy. The initial educational outreach and changes to the electronic health record and later augmentation with the electronic flag had additive effects, highlighting the importance of multilevel interventions to speed adoption of evidence-based antithrombotic prescribing.
Study context
- Population
- Adults prescribed direct oral anticoagulants (DOACs) in the ambulatory setting in Veterans Health Administration (VHA) health systemspatients by site group · 7 intervention sites 27,588 · 128 control sites 253,085
- Participants
- 27,588 vs 253,085
- Exposure
- intervention compared with control sites, controlling for preintervention trends
- Intervention sitesn = 27,588
- Control sitesn = 253,085
- Outcome
- Monthly site-level percentage of patients prescribed antiplatelet medications (difference in the semiannual change, intervention vs control sites)
- Follow-up
- After the 2 interventions had been implemented
Main finding
As reported in the abstract
Difference in change
−0.58 percentage points (pp) per 6 months
95% CI −0.95 to −0.22
Intervention sites vs Control sites
difference in change −0.58 percentage points (pp) per 6 months (95% CI −0.95 to −0.22)
Observational data: associations, not effects.
Further findings
| Outcome | absolute change (pp per 6 months) (95% CI) | |
|---|---|---|
| Antiplatelet use, by intervention stage · initial set of interventions | −0.29 (−0.61 to 0.04) | |
| Antiplatelet use, by intervention stage · later augmentation with the electronic flag | −0.29 (−0.61 to 0.03) | |
| Antiplatelet use, subgroup of patients with stable coronary artery disease · combined interventions · subgroup analysis | −2.1 (−3.0 to −1.2) | |
| −4−202Difference, pp per 6 months (linear scale) |
| Outcome | Intervention sites | Control sites | Estimate |
|---|---|---|---|
| Preintervention antiplatelet use in patients prescribed DOACs | 26.1% (95% CI 26.0%–26.1%) | 30.1% (95% CI 30.0%–30.2%) |
- Preintervention antiplatelet use in patients prescribed DOACs — Females, intervention sites
- 704 [2.6%]
- Preintervention antiplatelet use in patients prescribed DOACs — Females, control sites
- 6481 [2.6%]
- Antiplatelet use, subgroup of patients with stable coronary artery disease — additional change compared with the baseline prevalence in this group
- −5.5%
Original publication
Multilevel Stewardship Intervention for Use of Anticoagulation-Antiplatelet Therapy. JAMA Intern Med. Published 1 August 2026. doi:10.1001/jamainternmed.2026.2036
Summarised from the published abstract; every number is checked against it