Reducing Potentially Inappropriate Medication Prescribing for Older Patients: Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUIPPED)
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 74
- Locations
- 4
- Primary Endpoint
- Percentage of PIMs Prescribed
Study Overview
Brief Summary
This research is being conducted to learn which implementation strategy of EQUIPPED is most effective to improve prescribing practices of ED providers toward older Veterans and determine the factors influencing implementation of this program to reduce the prescribing of PIMs to older adults upon discharge from the ED. The study has three research aims. The procedures for these research aims are described below:
- Aim 1 - Examining the Impact of Passive Provider Feedback vs. Active Provider Feedback Through a Randomized Trial
- Aim 2 - Determination of Factors Affecting Organizational Adoption of EQUIPPED
- Aim 3 - Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention
Detailed Description
Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. In order to inform a Veterans Affairs (VA) system-wide approach to improve prescribing safety for older Veterans, the investigators will conduct a study to determine best practices for influencing provider prescribing behavior in order to decrease PIMs prescribed for older Veterans at the time of ED discharge. The overall goal of this project is to determine which EQUIPPED implementation strategy (active or passive feedback) is most effective to reduce prescribing of PIMs for older Veterans discharged from the ED.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Prescribers at VA Medical Centers that are implementing EQUIPPED
- •Members of the EQUIPPED implementation team at enrolled sites
Exclusion Criteria
- •Providers at VA Medical Centers that are not part of the upcoming EQUIPPED implementation trial.
Arms & Interventions
Active Feedback
EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
Intervention: EQUIPPED with Active Feedback (Other)
Passive Feedback
EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
Intervention: EQUIPPED with Passive Feedback (Other)
Outcomes
Primary Outcomes
Percentage of PIMs Prescribed
Time Frame: 12-Months Post Implementation of EQUIPPED
Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED.
Secondary Outcomes
- Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention(12-Months Post Implementation of EQUIPPED)
- Social Cognitive Theory Survey - Perceived Control Domain(12-Months After the Delivery of the First EQUIPPED Report)