A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program.
academic detailing
aging
audit and feedback
clinical decision support
emergency department
medication safety
Journal
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
ISSN: 1553-2712
Titre abrégé: Acad Emerg Med
Pays: United States
ID NLM: 9418450
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
revised:
09
02
2023
received:
15
09
2022
accepted:
12
02
2023
medline:
17
5
2023
pubmed:
16
2
2023
entrez:
15
2
2023
Statut:
ppublish
Résumé
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. 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. 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. 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.
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
340-348Subventions
Organisme : HSRD VA
ID : I01 HX002527
Pays : United States
Investigateurs
Jane Driver
(J)
Chi Mac
(C)
Lancer Scott
(L)
Rohit Manaktala
(R)
Peter Calkins
(P)
Jaimie Ostrom
(J)
Lauren Abbate
(L)
Rebecca Beyth
(R)
Patrick Cellarosi-Yorba
(P)
Jeffrey Violette
(J)
Amy Minix
(A)
Tracy Putnam
(T)
Kevin Corcoran
(K)
Michael Carter
(M)
Informations de copyright
Published 2023. This article is a U.S. Government work and is in the public domain in the USA.
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