Setting
This pragmatic prospective randomized trial will be conducted within one health care system, Michigan Medicine. Michigan Medicine includes more than 4000 clinicians who provided care in over 2.6 million patient clinic visits in fiscal year 2022. The anticoagulation clinic includes four pharmacists and ten nursing staff members who provide care to more than 3000 warfarin-treated patients. In 2020, the anticoagulation clinic staff began monitoring for appropriate DOAC prescribing using a dashboard built within the EHR. A single-day (December 21, 2020) cross-sectional analysis at Michigan Medicine found 9325 patients had DOAC use documented by 1002 primary care, cardiology, hematology, or surgery prescribers (median 23 patients/prescriber, interquartile range [IQR] 7–47). Of these, 670 (7.2%) patients (among 250 unique prescribers) did not follow evidence-based guidelines, with a median of 2 (IQR 1–5) unsafe DOAC prescriptions per prescriber observed on that single-day snapshot.