Abstract 198: Assessing Performance Perceptions And Realities In Outpatient Atrial Fibrillation Care

Introduction: Clinician self-perception is the basis of assessments of care quality in the absence of frequent, quantitative reports on clinical guideline adherence. However, physicians’ self-assessments may reflect an unconscious upward bias. We suspect that gaps exist between clinician perception of care and the care that patients actually receive. We focus on outpatient treatment of atrial fibrillation (AF) patients, as performance measure (PM) rates are variable in AF, and because the introduction of novel anticoagulants has the potential to impact established stroke prevention regimes. Hypothesis: This study investigates the gaps between provider perceptions of AF care and documented performance on outpatient AF treatment. We hypothesize that perceptions of performance on AF outpatient PMs will exceed documented performance. Methods: A survey of PINNACLE Registry participants, including 37 physicians, 6 NPs, 3 PAs and 4 RNs was conducted July-August 2011 to assess clinician perception of outpatient AF treatment. Responses were compared to data collected in the ACC’s PINNACLE Registry, an outpatient registry with 222,451 AF patients from over 300 sites. Results: Gaps were revealed between provider perceptions of AF care and in documented care from PINNACLE. Providers overestimated the time spent in the therapeutic INR range, stating that their patients are in the optimal range 70.2% of time (average of 49 responses providing individual percentage range). Best estimates from literature indicate that patients, on average, are in the therapeutic range 55% of time 1 . Clinicians also overestimated the percent of time that they prescribe anticoagulants, estimating that they were prescribed to 93% of eligible patients (average of 49 responses providing individual percentage range). According to PINNACLE, only 60.4% (38841 of 64318) of eligible patients are receiving anticoagulants, leaving 21,225 patients at possible risk for stroke. Finally, clinicians predicted that 66.7% of their patients with AF have two or more risk factors for stroke. Yet, only 13% (11091 of 85433) of patients had their thromboembolic risk factors documented. Conclusion: There is a discrepancy between the care patients with AF should be receiving and the care they actually receive in practices, as documented in the PINNACLE Registry. The gap between clinician perception and reality highlights the importance of CV registries and of regular feedback reporting on clinician performance. 1. The PINNACLE Registry does not measure time spent in therapeutic INR range. This statistic from Baker, WL, Cios DA, Sander SD et al. Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. Journal of Managed Care Pharmacy . 2009;15:244_52.