Improve Clinic Efficiencies with Home INR Monitoring
Applying the Management by Exception principle to your Home INR Monitoring patients can help improve your clinical and operational efficiencies.
Adopting a Management by Exception principle allows you to focus on patients with greater clinical needs, while improving your practice efficiencies. If patients report directly to Alere, either live or into our secure database management system, we can:
- Alert you only when a patient is out-of-range
- Send you all patient test results on the schedule you choose
- Offer options to access patient results electronically
The Management by Exception option for patient results allows you to receive an alert only when the patient is out-of-range as defined by you. Alere can assist your practice with the majority of patients who maintain in-range INR results, while allowing you to concentrate on those patients needing intervention or at higher risk.
Improving practice time in range leads to greater office productivity and efficiency, as patients who are in range require less time to manage. As a result, clinics are able to reallocate practice resources to higher risk patients or see more patients per day who are in their target range.1
Establish an Outpatient Protocol
The results of the “Warfarin management by exception, use of an outpatient protocol with patient self-testers” study (pending publishing) found significant clinical benefits for the patient and operational benefits to the provider.1 Use of a physician-issued outpatient protocol for patient self-testing is referenced in Medicare’s National Coverage Decision for patient self-testing and was used in 10 studies evaluated by Medicare prior to issuing reimbursement for self-testing.2
Clinical Results of the Outpatient Protocol
Patient safety was a primary endpoint of the Management by Exception study. Results included a dramatic 37% reduction in the incidence of critical value test results (INR tests less than 1.5 or greater than 5.0) in the study phase that used the outpatient protocol.3
The TTR between the baseline and the protocol arm was non-statistically significant, however; the outpatient protocol use arm was 37% less likely to encounter the 3.5 and 6 fold increased risk of stroke or major bleeding associated with critical value test results.4, 2
It appears written instructions may be more effective for patients to follow than telephonic counselling where hearing and interpretation of healthcare provider counselling may result in patient error.
Operational Benefits for use of the Outpatient Protocol
Dramatic operational and financial improvements were also seen in clinics that relied on their patients to follow the outpatient protocol for INR’s between 1.8 and 3.9.3
Cost avoidance, improved warfarin control, and improved patient safety resulted when an outpatient protocol provided weekly patient self-testers easy to follow instructions for out-of-range results (1.8 – 3.9). Increased practice efficiency resulted in less telephonic follow-up management time for weekly self-testers.
- Heneghan C, et al. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet. 2006; 367:404-11.
- Center for Medicare and Medicaid Services. Decision Memo for Prothrombin Time (INR) Monitor for Home Anticoagulation Management (CAG-00087C) [Memorandum]. 2001. Baltimore, MD.
- Burgwinkle, P. 2013, Warfarin management by exception, use of an outpatient protocol with patient self-testers. [pending publishing].
- Hylek, E. New England Journal of Medicine. 1996. Vol.335, No.8, p.540-6.
Alere™ Home INR Monitoring offers greater visibility and tighter control.
The STABLE Study demonstrates weekly patient self-testing provides sustained high quality, cost-effective warfarin control.
Contact Alere at 1.866.408.1205 for more information.