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

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

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

Study Overview

• Status: Completed
• Conditions: Aging
• Intervention / Treatment: Other: EQUIPPED with Active Feedback; Other: EQUIPPED with Passive Feedback

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.

• Study Type: Interventional
• Enrollment (Actual): 74
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35233-1927
      • Birmingham VA Medical Center, Birmingham, AL
  • Georgia
    • Decatur, Georgia, United States, 30033-4004
      • Atlanta VA Medical and Rehab Center, Decatur, GA
  • North Carolina
    • Durham, North Carolina, United States, 27705-3875
      • Durham VA Medical Center, Durham, NC
  • Utah
    • Salt Lake City, Utah, United States, 84148-0001
      • VA Salt Lake City Health Care System, Salt Lake City, UT

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 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.	Other: 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.
Active Comparator: Passive Feedback; EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.	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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of PIMs Prescribed	Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED.	12-Months Post Implementation of EQUIPPED

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Social Cognitive Theory Survey - Perceived Control Domain	Prescribers at participating EDs completed a survey at baseline, 6, and 12 months to assess perceived control related to prescribing as a factor that could be impacted by the EQUIPPED intervention. The outcome relates to the average reported perception of 'control' across site respondents by implementation group assignment. The 'perceived control' domain is assessed with a 1-5 Likert scale where 1=strongly disagree and 5=strongly agree with the statement, "I am in control of reducing the potentially inappropriate medications that I prescribe for older Veterans at the time of emergency department."	12-Months After the Delivery of the First EQUIPPED Report
Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention	Micro-costing of the intervention will be done to learn details of specific factors that may impact the cost of the intervention to the Veterans Health Administration (organization)	12-Months Post Implementation of EQUIPPED

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Collaborators: Durham VA Health Care System; VA Salt Lake City Health Care System; Birmingham, Alabama VA Medical Center
• Investigators: Principal Investigator: George Lee Jackson, PhD MHA, Durham VA Medical Center, Durham, NC; Principal Investigator: Elizabeth Camille Vaughan, MD MS, Atlanta VA Medical and Rehab Center, Decatur, GA

Publications and helpful links

General Publications

• 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.
• 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.
• Vaughan CP, Burningham Z, Kelleher JL, McGwin G, Jasien CL, Hastings SN, Stevens MB, Morris I, Jackson GL; The EQUIPPED VA Implementation QI Group. A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program. Acad Emerg Med. 2023 Apr;30(4):340-348. doi: 10.1111/acem.14697. Epub 2023 Mar 8.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2019
• Primary Completion (Actual): December 31, 2022
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: June 28, 2019
• First Submitted That Met QC Criteria: June 28, 2019
• First Posted (Actual): July 2, 2019

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 6, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Emergency Department; Older Adults; Quality Improvement; Inappropriate Prescribing; Potentially Inappropriate Medications; Veteran Health
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Pathological Conditions, Signs and Symptoms; Emergencies
• Other Study ID Numbers: IIR 17-236; IIR HX00257-01A1 (Other Grant/Funding Number: VA Health Services Research & Development)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: A de-identified, anonymized dataset will be created and shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No