Studies reporting TTR as an outcome for patients receiving VKA therapy found no difference between those receiving supplemental education and control groups (MD, 2.40% higher [95% CI, 2.79% lower to 7.58% higher]; low certainty). Supplemental education was effective in improving patient perfor- mance on various knowledge assessments (standardized MD, 0.77 higher [95% CI, 0.43-1.11 higher]; low certainty). Harms and burden. Although supplemental education might reduce the risk of bleeding in patients that were at average risk for bleeding compared with control patients (RR, 0.54 [95% CI, 0.06 to 4.76]; ARR, 8 fewer per 1000 [95% CI, 16 fewer to 64 more]; very low certainty), the effect estimate is very imprecise, and CIs include large benefit and great harm. Other EtD criteria and considerations. The guideline panel determined that the uncertainty about resources required to implement this intervention is large, depending on the nature of the intervention itself. Some interventions consisted of a 5-minute whereas others involved 20 to 30 minutes of one-on-one The cost-effectiveness of supplemental education could not be determined, as there were no available studies. The panel agreed that individual patients will have different experiences when supplemental education is delivered, in part due to differ- ences in the manner in which health care providers deliver the intervention. There may also be differences between patients receiving DOACs and those receiving VKA, given that patients on DOACs may not receive the same level of follow-up or may be less likely to receive care in specialized AMSs. According to some panel members, supplemental education might increase health care equity if it is uniformly administered in a consistent way; others thought that equitable delivery is unlikely. 