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

Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED

Sponsors

Lead sponsor: VA Office of Research and Development

Collaborator: Durham VA Health Care System
VA Salt Lake City Health Care System
Birmingham, Alabama VA Medical Center

Source VA Office of Research and Development
Brief 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

Detailed 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.

Overall Status Recruiting
Start Date October 1, 2019
Completion Date September 30, 2022
Primary Completion Date March 31, 2021
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Percentage of PIMs Prescribed 12-Months Post Implementation of EQUIPPED
Secondary Outcome
Measure Time Frame
Impact of EQUIPPED on Behavior Change and Factors impacting implementation 12-Months After the Delivery of the First EQUIPPED Report
Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention 12-Months Post Implementation of EQUIPPED
Enrollment 480
Condition
Intervention

Intervention type: Other

Intervention name: EQUIPPED with Active Feedback

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. 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.

Arm group label: Active Feedback

Intervention type: Other

Intervention name: EQUIPPED with Passive Feedback

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. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.

Arm group label: Passive Feedback

Eligibility

Criteria:

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.

Gender: All

Minimum age: N/A

Maximum age: N/A

Healthy volunteers: No

Overall Official
Last Name Role Affiliation
Elizabeth Camille Vaughan, MD MS Principal Investigator Atlanta VA Medical and Rehab Center, Decatur, GA
Overall Contact

Last name: Elizabeth C Vaughan, MD MS

Phone: (404) 321-6111

Phone ext: 3710

Email: [email protected]

Location
facility status contact investigator
Birmingham VA Medical Center, Birmingham, AL | Birmingham, Alabama, 35233, United States Recruiting Kathryn L Burgio, PhD MA BA 205-933-8101 7307 [email protected] Kathryn L Burgio, PhD MA BA Sub-Investigator
Atlanta VA Medical and Rehab Center, Decatur, GA | Decatur, Georgia, 30033, United States Recruiting Elizabeth C Vaughan, MD MS (404) 321-6111 3710 [email protected] Elizabeth Camille Vaughan, MD MS Principal Investigator
Durham VA Medical Center, Durham, NC | Durham, North Carolina, 27705, United States Recruiting George L Jackson, PhD MHA (919) 286-6936 [email protected] George Lee Jackson, PhD MHA Sub-Investigator
VA Salt Lake City Health Care System, Salt Lake City, UT | Salt Lake City, Utah, 84148, United States Recruiting Zachary R Burningham, PhD (801) 582-1565 4169 [email protected] Zachary Robert Burningham, PhD Sub-Investigator
Location Countries

United States

Verification Date

March 2020

Responsible Party

Responsible party type: Sponsor

Keywords
Has Expanded Access No
Number Of Arms 2
Arm Group

Arm group label: Active Feedback

Arm group type: Active Comparator

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.

Arm group label: Passive Feedback

Arm group type: Active Comparator

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

Acronym EQUIPPED
Patient Data No
Study Design Info

Allocation: Randomized

Intervention model: Parallel Assignment

Intervention model description: 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 purpose: Health Services Research

Masking: None (Open Label)

Source: ClinicalTrials.gov