title: Enhancing the Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUiPPED): Preliminary Results from Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department, a Novel Multicomponent Interdisciplinary Quality Improvement Initiative.
abstract: Suboptimal medication prescribing for older adults has been described in a number of emergency department (ED) studies. Despite this, few studies have examined ED-targeted interventions aimed at reducing the use of potentially inappropriate medications (PIMs). Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the ED (EQUiPPED) is an ongoing multicomponent, interdisciplinary quality improvement initiative in eight Department of Veterans Affairs EDs. The project aims to decrease the use of PIMs, as identified by the Beers criteria, prescribed to veterans aged 65 and older at the time of ED discharge. Interventions include provider education; informatics-based clinical decision support with electronic medical record-embedded geriatric pharmacy order sets and links to online geriatric content; and individual provider education including academic detailing, audit and feedback, and peer benchmarking. Poisson regression was used to compare the number of PIMs that staff providers prescribed to veterans aged 65 and older discharged from the ED before and after the initiation of the EQUiPPED intervention. Initial data from the first implementation site show that the average monthly proportion of PIMs that staff providers prescribed was 9.4±1.5% before the intervention and 4.6±1.0% after the initiation of EQUiPPED (relative risk=0.48, 95% confidence interval=0.40-0.59, P<.001). Preliminary evaluation demonstrated a significant and sustained reduction of ED-prescribed PIMs in older veterans after implementation of EQUiPPED. Longer follow-up and replication at collaborating sites would allow for an assessment of the effect on health outcomes and costs.
authors.affiliation: Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.|Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.|Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Stevens
authors.affiliation: Department of Veterans Affairs Geriatric Research, Education, and Clinical Center, Durham, North Carolina.|Health Services Research and Development Center, Durham, North Carolina.|Durham Veterans Affairs Medical Center, Durham, North Carolina.|Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Susan Nicole
authors.initials: SN
authors.lastname: Hastings
authors.affiliation: Department of Veterans Affairs Geriatric Research, Education, and Clinical Center, Nashville, Tennessee.|Tennessee Valley Veterans Affairs Health System, Nashville, Tennessee.|Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: James
authors.initials: J
authors.lastname: Powers
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Vandenberg
authors.affiliation: Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.|Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.|Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Katharina V
authors.initials: KV
authors.lastname: Echt
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, North Carolina.
authors.forename: William E
authors.initials: WE
authors.lastname: Bryan
authors.affiliation: Tennessee Valley Veterans Affairs Health System, Nashville, Tennessee.|Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Kiffany
authors.initials: K
authors.lastname: Peggs
authors.affiliation: Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.|Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Alayne D
authors.initials: AD
authors.lastname: Markland
authors.affiliation: Department of Veterans Affairs, Geriatric Research, Education, and Clinical Center, Bronx, New York.|Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.|Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Ula
authors.initials: U
authors.lastname: Hwang
authors.affiliation: Department of Veterans Affairs, Geriatric Research, Education, and Clinical Center, Bronx, New York.|Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: William W
authors.initials: WW
authors.lastname: Hung
authors.affiliation: Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Schmidt
authors.affiliation: Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.|Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.affiliation: Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.|Department of Emergency Medicine, Emory University, Atlanta, Georgia.
authors.forename: Edidiong
authors.initials: E
authors.lastname: Ikpe-Ekpo
authors.affiliation: Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.|Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.|School of Nursing, Emory University, Atlanta, Georgia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Clevenger
authors.affiliation: Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.|Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.|Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Johnson
authors.affiliation: Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.|Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.|Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Camille P
authors.initials: CP
authors.lastname: Vaughan
mesh_terms: D000368:Aged; D011307:Drug Prescriptions / Q000592:standards*; D004636:Emergency Service, Hospital; D006801:Humans; D010351:Patient Discharge; D058996:Quality Improvement; D058014:Veterans Health
keywords: aged 65 and older; emergency department; inappropriate prescribing; quality improvement; veterans health