Assessing Anticoagulation Management and Shared Decision-Making Documentation from Providers Participating in the SUPPORT-AF Study

Background We previously tested an intervention featuring educational outreach with modified academic detailing (AD) to increase anticoagulation (AC) use in patients with atrial fibrillation (AF). Currently, we compare providers receiving and not receiving AD in terms of inclusion of our AD educational topics and shared decision-making elements in documentation. Methods Physicians reviewed themes discussed with providers during AD and evaluated charts for evidence of shared decision-making. We then compared frequency of documentation of individual items for providers receiving AD compared with non-AD providers. To understand baseline documentation practices of AD providers, we also randomly selected encounters of AD providers before their AD participation. Results There were 113 eligible encounters in the four months after AD - 36 from AD providers and 77 from non-AD providers. We also identified 35 encounters from AD providers before participating in the intervention. Providers infrequently documented many reviewed items (% documenting): AC mentioned (44%), multiple options for AC (5%), CHA2DS2-VASc score (11%), bleeding risk factors (2%). Compared with non-AD providers, AD providers had statistically significant higher percentages for the following items: mention of AC (64% versus 35%), stroke risk (11% versus 0%), AC benefits (8% versus 0%), patient involvement (70% versus 0%). There was no improvement, however, for AD providers compared with baseline documentation percentages. Conclusions Providers infrequently documented important items in AC management and shared decision-making. AD participation did not improve documentation. Improving adoption of AD educational items may require more prolonged interaction with providers. Improving shared decision-making may require an intervention more focused on it and its documentation. Trial Registration The trial was registered as NCT03583008 on Clinicaltrials.gov on July 11, 2018.