Enhancing the Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUiPPED): Preliminary Results from Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department,a Novel Multicomponent Interdisciplinary Quality Improvement Initiative |
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| Authors: | Melissa B. Stevens MD Susan Nicole Hastings MD James Powers MD Ann E. Vandenberg PhD MPH Katharina V. Echt PhD William E. Bryan PharmD III Kiffany Peggs MD Alayne D. Markland DO MSc Ula Hwang MD MPH William W. Hung MD MPH Anita J. Schmidt RN MEd Gerald McGwin PhD Edidiong Ikpe‐Ekpo MD MPH Carolyn Clevenger RN DNP Theodore M. Johnson MD MPH II Camille P. Vaughan MD MS |
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| Affiliation: | 1. Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia;2. Atlanta Veterans Affairs Medical Center, Atlanta, Georgia;3. Department of Medicine, Emory University, Atlanta, Georgia;4. Department of Veterans Affairs Geriatric Research, Education, and Clinical Center, Durham, North Carolina;5. Health Services Research and Development Center, Durham, North Carolina;6. Durham Veterans Affairs Medical Center, Durham, North Carolina;7. Department of Medicine, Duke University, Durham, North Carolina;8. Department of Veterans Affairs Geriatric Research, Education, and Clinical Center, Nashville, Tennessee;9. Tennessee Valley Veterans Affairs Health System, Nashville, Tennessee;10. Department of Medicine, Vanderbilt University, Nashville, Tennessee;11. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;12. Department of Veterans Affairs, Geriatric Research, Education, and Clinical Center, Bronx, New York;13. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York;14. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York;15. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama;16. Department of Emergency Medicine, Emory University, Atlanta, Georgia;17. School of Nursing, Emory University, Atlanta, Georgia |
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| Abstract: | ![]()
Suboptimal medication prescribing for older adults has been described in a number of emergency department (ED) studies. Despite this, few studies have examined ED‐targeted interventions aimed at reducing the use of potentially inappropriate medications (PIMs). Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the ED (EQUiPPED) is an ongoing multicomponent, interdisciplinary quality improvement initiative in eight Department of Veterans Affairs EDs. The project aims to decrease the use of PIMs, as identified by the Beers criteria, prescribed to veterans aged 65 and older at the time of ED discharge. Interventions include provider education; informatics‐based clinical decision support with electronic medical record–embedded geriatric pharmacy order sets and links to online geriatric content; and individual provider education including academic detailing, audit and feedback, and peer benchmarking. Poisson regression was used to compare the number of PIMs that staff providers prescribed to veterans aged 65 and older discharged from the ED before and after the initiation of the EQUiPPED intervention. Initial data from the first implementation site show that the average monthly proportion of PIMs that staff providers prescribed was 9.4 ± 1.5% before the intervention and 4.6 ± 1.0% after the initiation of EQUiPPED (relative risk = 0.48, 95% confidence interval = 0.40–0.59, P < .001). Preliminary evaluation demonstrated a significant and sustained reduction of ED‐prescribed PIMs in older veterans after implementation of EQUiPPED. Longer follow‐up and replication at collaborating sites would allow for an assessment of the effect on health outcomes and costs. |
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| Keywords: | quality improvement emergency department inappropriate prescribing aged 65 and older veterans health |
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