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A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program.
Vaughan, Camille P; Burningham, Zach; Kelleher, Jessica L; McGwin, Gerald; Jasien, Christine L; Hastings, S Nicole; Stevens, Melissa B; Morris, Isis; Jackson, George L.
Afiliación
  • Vaughan CP; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, USA.
  • Burningham Z; Department of Medicine, Division of Geriatrics and Gerontology, Emory University, Atlanta, Georgia, USA.
  • Kelleher JL; Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, USA.
  • McGwin G; Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.
  • Jasien CL; Atlanta VA Healthcare System, Atlanta, Georgia, USA.
  • Hastings SN; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, USA.
  • Stevens MB; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • Morris I; Atlanta VA Healthcare System, Atlanta, Georgia, USA.
  • Jackson GL; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
Acad Emerg Med ; 30(4): 340-348, 2023 04.
Article en En | MEDLINE | ID: mdl-36790188
OBJECTIVES: The Enhancing the Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) medication safety program involves three core components including provider education, clinical decision support, and audit and feedback using the American Geriatrics Society Beers Criteria to determine potentially inappropriate medications (PIMs). This study evaluated implementation of audit and feedback through a centralized informatics-based dashboard compared to academic detailing delivered one on one by an EQUIPPED champion. METHODS: In a cluster-randomized study (October 2019-September 2021), eight VA emergency department (EDs) implemented either the academic detailing (n = 4) or the dashboard (n = 4) strategy for the audit and feedback component of EQUIPPED. The primary outcome was the monthly proportion of PIMs prescribed to Veterans 65 years or older at ED discharge. Poisson regression was used to evaluate the proportion of PIMs prescribed 6 months prior to EQUIPPED implementation compared to 12 months following implementation. RESULTS: Eight VA ED sites successfully implemented the EQUIPPED program. During the 6-month baseline period, the academic detailing and dashboard sites had similar PIM prescribing rates of 8.01% for academic detailing versus 8.04% for dashboard (p = 0.90). Comparing 12 months of prescribing data after EQUIPPED implementation, the academic detailing group significantly improved PIM prescribing (7.07%) compared to the dashboard group (8.10%; odds ratio 1.14, 95% confidence interval 1.08-1.22, p ≤ 0.0001). Within the groups, two of the four academic detailing sites demonstrated statistically significant reductions in PIM prescribing. One of the four dashboard sites achieved nearly 50% relative reduction in PIM prescribing. CONCLUSIONS: Eight VA EDs successfully implemented the core components of the EQUIPPED program amid the unprecedented challenges posed by the COVID-19 pandemic. While the academic detailing approach to EQUIPPED audit and feedback was more effective at the group level to improve safe prescribing for older Veterans discharged from the ED, the trial suggests that dashboard-based audit and feedback is a reasonable strategy in resource-limited settings.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 4_TD Problema de salud: 4_pneumonia Asunto principal: Prescripción Inadecuada / COVID-19 Tipo de estudio: Clinical_trials / Prognostic_studies / Sysrev_observational_studies Aspecto: Implementation_research Límite: Aged / Humans País/Región como asunto: America do norte Idioma: En Revista: Acad Emerg Med Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 4_TD Problema de salud: 4_pneumonia Asunto principal: Prescripción Inadecuada / COVID-19 Tipo de estudio: Clinical_trials / Prognostic_studies / Sysrev_observational_studies Aspecto: Implementation_research Límite: Aged / Humans País/Región como asunto: America do norte Idioma: En Revista: Acad Emerg Med Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos
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