# Overcoming barriers to warfarin patient self-management implementation in the US healthcare system

> **NIH AHRQ R18** · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · 2021 · $450,000

## Abstract

Project Summary
In the US, patients receiving warfarin therapy are rarely allowed to engage in patient self-management (PSM)
which is less burdensome, less expensive, and safer than standard clinician-directed warfarin management.
National and international evidence-based guideline panels strongly recommend PSM over other warfarin
management methods for appropriate patients because it improves INR control, cuts risk of thrombosis and
death by half without increasing bleeding risk, and increases patient satisfaction and quality of life. The
reasons behind PSM underutilization in US settings have not been systematically assessed and validated. We
will address this knowledge gap and provide foundational information for increasing PSM utilization within the
US healthcare system. Our Aim 1 will assess and validate barriers and facilitators to PSM and evaluate their
applicability to the US healthcare system; Aim 2 will develop and test PSM implementation strategies in US
ambulatory care sites using rapid-cycle research methodology; and Aim 3 will assess implementation
(feasibility, fidelity, adoption), clinical (effectiveness, safety, equity, patient-centeredness), and end-user
(satisfaction) outcomes. The long-term objective of our application is to improve the safety of ambulatory
warfarin therapy through increasing the implementation of PSM. Our application supports the mission of the
AHRQ by improving the safety of medication and improvement in overall health and focuses on a specified
area of interest, namely an intervention (PSM) that implements a measure, metric, tool, and/or practice to
ensure appropriate monitoring for individuals receiving high risk treatments in the ambulatory care setting such
as anticoagulation therapy. Our research proposal is guided by an implementation science logic model that
incorporates well-known implementation science frameworks to support the specific aims. Qualitative data
collection and analysis for Aim 1 will be organized using the Consolidated Framework for Implementation
Research (CFIR) a determinant framework that identifies five domains influencing implementation:
Intervention, Inner Setting, Outer Setting, Individuals, and the Implementation Process. Constructs within each
domain provide guidance on factors to identify and measure as potential implementation barriers or facilitators.
PSM implementation activities in Aim 2 will be guided by the Quality Implementation Framework (QIF), which
identifies the critical implementation process steps and specific actions related to these steps that can be
utilized to achieve quality PSM implementation. Implementation strategies will be supported by the rapid-cycle
research framework developed by the AHRQ Practice Based Research Network. Implementation outcomes in
Aim 3 will be structured using the well-known Reach, Efficacy, Adoption, Implementation, Maintenance (RE-
AIM) framework. We will utilize a type III hybrid research design to test PSM implementation strateg...

## Key facts

- **NIH application ID:** 10172303
- **Project number:** 1R18HS027960-01
- **Recipient organization:** UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
- **Principal Investigator:** Daniel M. Witt
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $450,000
- **Award type:** 1
- **Project period:** 2021-05-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10172303

## Citation

> US National Institutes of Health, RePORTER application 10172303, Overcoming barriers to warfarin patient self-management implementation in the US healthcare system (1R18HS027960-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10172303. Licensed CC0.

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