Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED

Aging Clinical Trial

— EQUIPPED  

Official title:

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

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04004936
• Other study ID #: IIR 17-236
• Secondary ID: IIR HX00257-01A1
• Status: Active, not recruiting
• Phase: N/A
• Start date: October 1, 2019
• Est. completion date: March 31, 2024

Study information

• Verified date: September 2023
• Source: VA Office of Research and Development
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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

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.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 73
• Est. completion date: March 31, 2024
• Est. primary completion date: December 31, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

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.

Related Conditions & MeSH terms

• Aging

Intervention

Other:
• EQUIPPED with Active Feedback
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.
• EQUIPPED with Passive Feedback
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.

Locations

Country	Name	City	State
United States	Birmingham VA Medical Center, Birmingham, AL	Birmingham	Alabama
United States	Atlanta VA Medical and Rehab Center, Decatur, GA	Decatur	Georgia
United States	Durham VA Medical Center, Durham, NC	Durham	North Carolina
United States	VA Salt Lake City Health Care System, Salt Lake City, UT	Salt Lake City	Utah

Sponsors (4)

Lead Sponsor	Collaborator
VA Office of Research and Development	Birmingham, Alabama VA Medical Center, Durham VA Health Care System, VA Salt Lake City Health Care System

Country where clinical trial is conducted

United States, 

References & Publications (7)

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. — View 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 — View 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). — View 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 — View 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 — View 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. — View 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 — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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	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
Secondary	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