Clinical trial NCT04004936: Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED
Official title: Reducing Potentially Inappropriate Medication Prescribing for Older Patients: Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUIPPED)
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Aging
Keywords: Emergency Department
Potentially Inappropriate Medications
Inappropriate Prescribing
Quality Improvement
Veteran Health
Older Adults
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
Collaborators: name: Durham VA Health Care System
name: VA Salt Lake City Health Care System
name: Birmingham, Alabama VA Medical Center
First posted: 2019-07-02
Enrollment: 74
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention 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.
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

Eligibility criteria: 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.

Primary outcomes:
measure: Percentage of PIMs Prescribed
timeFrame: 12-Months Post Implementation of EQUIPPED
Secondary outcomes:
measure: Impact of EQUIPPED on Behavior Change and Factors Impacting Implementation
timeFrame: 12-Months After the Delivery of the First EQUIPPED Report
measure: Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention
timeFrame: 12-Months Post Implementation of EQUIPPED
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: Birmingham VA Medical Center, Birmingham, AL
state: Alabama
city: Decatur
country: United States
facility: Atlanta VA Medical and Rehab Center, Decatur, GA
state: Georgia
city: Durham
country: United States
facility: Durham VA Medical Center, Durham, NC
state: North Carolina
city: Salt Lake City
country: United States
facility: VA Salt Lake City Health Care System, Salt Lake City, UT
state: Utah
Study officials:
affiliation: Atlanta VA Medical and Rehab Center, Decatur, GA
name: Elizabeth Camille Vaughan, MD MS
role: PRINCIPAL_INVESTIGATOR
affiliation: Durham VA Medical Center, Durham, NC
name: George Lee Jackson, PhD MHA
role: PRINCIPAL_INVESTIGATOR
References:
citation: Burningham Z, Chen W, Sauer BC, Richter Lagha R, Hansen J, Huynh T, Patel S, Leng J, Halwani A, Kramer BJ. VA Geriatric Scholars Program's impact on prescribing potentially inappropriate medications. Am J Manag Care. 2019 Sep;25(9):425-430.
citation: Peters CB, Hansen JL, Halwani A, Cho ME, Leng J, Huynh T, Burningham Z, Caloyeras J, Matsuda T, Sauer BC. Validation of Algorithms Used to Identify Red Blood Cell Transfusion Related Admissions in Veteran Patients with End Stage Renal Disease. EGEMS (Wash DC). 2019 Jul 3;7(1):23. doi: 10.5334/egems.257.
citation: Burningham Z, Jackson GL, Kelleher J, Stevens M, Morris I, Cohen J, Maloney G, Vaughan CP. The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED? Clin Ther. 2020 Apr;42(4):573-582. doi: 10.1016/j.clinthera.2020.02.013. Epub 2020 Mar 25.
citation: Lewinski AA, Crowley MJ, Miller C, Bosworth HB, Jackson GL, Steinhauser K, White-Clark C, McCant F, Zullig LL. Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake. Med Care. 2021 Jun 1;59(Suppl 3):S242-S251. doi: 10.1097/MLR.0000000000001553.
citation: Chien HC, Morreall D, Patil V, Rasmussen KM, Yong C, Li C, Passey DG, Burningham Z, Sauer BC, Halwani AS. Treatment Patterns and Outcomes in a Nationwide Cohort of Older and Younger Veterans with Waldenstrom Macroglobulinemia, 2006-2019. Cancers (Basel). 2021 Apr 4;13(7):1708. doi: 10.3390/cancers13071708.
citation: Passey D, Healy R, Qualls J, Hamilton CJ, Tilley E, Burningham Z, Sauer B, Halwani A. Development and implementation of a pharmacist-led telehealth medication management program for veterans receiving oral antineoplastic therapies through the MISSION Act. Am J Health Syst Pharm. 2022 May 24;79(11):835-843. doi: 10.1093/ajhp/zxac023.
citation: Friedman DR, Patil V, Li C, Rassmussen KM, Burningham Z, Hamilton-Hill S, Kelley MJ, Halwani AS. Integration of Patient-Reported Outcome Measures in the Electronic Health Record: The Veterans Affairs Experience. JCO Clin Cancer Inform. 2022 Feb;6:e2100086. doi: 10.1200/CCI.21.00086.
citation: Burningham Z, Jackson GL, Kelleher JL, Morris I, Stevens MB, Cohen J, Maloney G, Sauer BC, Halwani AS, Chen W, Vaughan CP. Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics. Appl Clin Inform. 2023 Aug;14(4):684-692. doi: 10.1055/s-0043-1771393. Epub 2023 Aug 30.