Combining quality improvement and geriatrics training: the nursing home polypharmacy outcomes project.
To examine sustained effects of an educational intervention, the authors repeated a successful quality improvement (QI) project on medication safety and cost effectiveness. In October 2007 and August 2008, the facility leadership and geriatrics faculty identified all patients receiving nine or more medications (polypharmacy cohort) in a 170-bed teaching nursing home. They then taught Geriatric Medicine fellows (n = 12 in 2007, 11 in 2008) to (a) systematically collect medication data; (b) generate medication recommendations (stop, taper, or continue) based on expert criteria (Beers criteria) or drug-drug interaction programs; (c) discuss recommendations with patients' attending physicians; and (d) implement approved recommendations. Over the two projects, the polypharmacy cohorts demonstrated decreased potentially inappropriate medications (odds ratio [OR] = .78, 95% confidence interval [95% CI] [0.69, 0.88], p < .001), contraindicated medications (OR = .63, 95% CI [0.47, 0.85], p = .002) and medication costs (OR = .97, 95% CI [0.96, 0.99], p < .001). Findings suggest that programs planning educational QI projects for trainees may benefit from a multiyear approach to maximize clinical and educational benefits.
a The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine , University of Hawaii , Honolulu , Hawaii , USA.
Gotaro
G
Kojima
Christina L
CL
Bell
Bruce
B
Tamura
James
J
Davis
Michiko
M
Inaba
Pia
P
Lorenzo
Patricia Lanoie
PL
Blanchette
Wendy
W
Iwasaki
Kamal
K
Masaki
D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005257:Fellowships and Scholarships; D005260:Female; D005853:Geriatrics / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009735:Nursing Homes; D019338:Polypharmacy; D058996:Quality Improvement
geriatric education; geriatric medicine fellowship; nursing homes; polypharmacy; quality improvement