Tailoring Antiplatelet Adherence: An EHR-Enabled Model for P2Y12 Inhibitor Therapy Among Veterans.

BACKGROUND: The use of P2Y12 inhibitor is highly variable, and administration is frequently confounded by inconsistent documentation that heightens risks for mismanagement, particularly following transitions of care. PROJECT RATIONALE: Insufficient documentation clearly defining the indication and therapeutic duration for antiplatelet agents carries potential risks for bleeding and/or ischemia. This was observed in patients who were veterans and was felt to represent a modifiable quality gap. PROJECT SUMMARY: A 2-phase quality improvement initiative at the New Mexico Veterans Affairs Health Care System reviewed documentation among 1,100 veterans prescribed a P2Y12 inhibitor. In a randomly selected sample of 135 patients, 27% lacked documentation clearly defining therapeutic duration, and 8.4% continued P2Y12 inhibitor beyond the intended stop date. A structured electronic health record document and automated reminders were developed using a Plan-Do-Study-Act framework to address these concerns. TAKE-HOME MESSAGE: Structured electronic health record documentation with automated reminders can improve antiplatelet stewardship and safety.