Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED (EQUIPPED)

VA Office of Research and Development

Status: Active, not recruiting

Conditions: Aging

Treatments: Other: EQUIPPED with Passive Feedback; Other: EQUIPPED with Active Feedback

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT04004936

IIR 17-236

IIR HX00257-01A1 (Other Grant/Funding Number)

Details and patient eligibility

About

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

Full 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.

Enrollment: 74 patients

Sex: All

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

74 participants in 2 patient groups

Active Feedback

Active Comparator group

Description:

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.

Treatment:

Other: EQUIPPED with Active Feedback

Passive Feedback

Active Comparator group

Description:

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

Treatment:

Other: EQUIPPED with Passive Feedback