Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED

NCT ID: NCT04004936

Last Updated: 2024-08-06

Study Results

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Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

74 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-01

Study Completion Date

2024-12-31

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.

Conditions

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Aging

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

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 Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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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.

Group Type ACTIVE_COMPARATOR

EQUIPPED with Active Feedback

Intervention Type OTHER

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.

Passive Feedback

EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.

Group Type ACTIVE_COMPARATOR

EQUIPPED with Passive Feedback

Intervention Type OTHER

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.

Interventions

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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.

Intervention Type OTHER

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.

Intervention Type OTHER

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.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Durham VA Health Care System

FED

Sponsor Role collaborator

VA Salt Lake City Health Care System

FED

Sponsor Role collaborator

Birmingham, Alabama VA Medical Center

FED

Sponsor Role collaborator

VA Office of Research and Development

FED

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Elizabeth Camille Vaughan, MD MS

Role: PRINCIPAL_INVESTIGATOR

Atlanta VA Medical and Rehab Center, Decatur, GA

George Lee Jackson, PhD MHA

Role: PRINCIPAL_INVESTIGATOR

Durham VA Medical Center, Durham, NC

Locations

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Birmingham VA Medical Center, Birmingham, AL

Birmingham, Alabama, United States

Site Status

Atlanta VA Medical and Rehab Center, Decatur, GA

Decatur, Georgia, United States

Site Status

Durham VA Medical Center, Durham, NC

Durham, North Carolina, United States

Site Status

VA Salt Lake City Health Care System, Salt Lake City, UT

Salt Lake City, Utah, United States

Site Status

Countries

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United States

References

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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.

Reference Type RESULT
PMID: 31518091 (View on PubMed)

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.

Reference Type RESULT
PMID: 31304183 (View on PubMed)

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.

Reference Type RESULT
PMID: 32222360 (View on PubMed)

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.

Reference Type RESULT
PMID: 33976073 (View on PubMed)

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.

Reference Type RESULT
PMID: 33916545 (View on PubMed)

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.

Reference Type RESULT
PMID: 35084462 (View on PubMed)

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.

Reference Type RESULT
PMID: 35290072 (View on PubMed)

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.

Reference Type RESULT
PMID: 37648222 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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IIR HX00257-01A1

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

IIR 17-236

Identifier Type: -

Identifier Source: org_study_id

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