Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED

Study Overview
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Brief Summary
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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
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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.

Official Title
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Reducing Potentially Inappropriate Medication Prescribing for Older Patients: Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUIPPED)

Conditions
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Aging

Intervention / Treatment
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* Other: EQUIPPED with Active Feedback
* Other: EQUIPPED with Passive Feedback


Participation Criteria
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Eligibility Criteria
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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.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: In order to inform a Veterans Affairs (VA) system-wide approach to improve prescribing safety for older Veterans, the investigators will conduct a randomized 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. Eight sites will be randomized to either active feedback with individual, in-person academic detailing or passive feedback delivered via an individualized electronic dashboard.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Active Feedback<br>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. | Other: EQUIPPED with Active Feedback<br>* 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. The active feedback group will receive 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.<br>|
| Active Comparator: Passive Feedback<br>EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. | Other: EQUIPPED with Passive Feedback<br>* 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. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of PIMs Prescribed | 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. | 12-Months Post Implementation of EQUIPPED | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Impact of EQUIPPED on Behavior Change and Factors impacting implementation | Prescribers at participating EDs will be asked to complete a brief survey at baseline, 6, and 12 months to assess key components of the social cognitive factors that we expect to be impacted by the intervention. Interviews will be conducted with EQUIPPED implementation team members to assess implementation facilitators and barriers. | 12-Months After the Delivery of the First EQUIPPED Report | 
| Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention | Micro-costing of the intervention will be done to learn details of specific factors that may impact the cost of the intervention to the organization. | 12-Months Post Implementation of EQUIPPED | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency Department, Potentially Inappropriate Medications, Inappropriate Prescribing, Quality Improvement, Veteran Health, Older Adults