title: Incidence- Versus Prevalence-Based Measures of Inappropriate Prescribing in the Veterans Health Administration.
abstract: OBJECTIVE
  To describe variations in potentially inappropriate prescribing (PIP) and characterize the extent to which switching to an incidence-based indicator would affect health system quality rankings.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Veterans Health Administration in 2011.
  
  
  METHODS
  Older adults receiving outpatient primary care.
  
  
  METHODS
  PIP was defined according to the National Committee for Quality Assurance High-Risk Medications in the Elderly list. Ranks were separately assigned for prevalent and incident PIP at the regional, network, and healthcare system levels.
  
  
  RESULTS
  National PIP prevalence was 12.3% (167,766/1,360,251), and incidence was 5.8% (78,604/1,360,251). PIP prevalence ranged from 3.5% to 33.1% across healthcare systems (interquartile range (IQR) = 9.2-15.5%). PIP incidence ranged from 1.2% to 14.9% (IQR = 4.1-7.2%). Rank order in PIP prevalence and incidence was correlated (Spearman correlation; ρ = 0.934, P < .001), although substantial changes in ranks were seen for some healthcare systems, with seven of 139 (5.0%) systems shifting more than 30 rank positions and 21 (15.1%) systems shifting 16 to 30 positions.
  
  
  CONCLUSIONS
  Prevalence- and incidence-based indicators of prescribing quality were strongly correlated. Transitioning to incidence-based indicators would not produce an initial disruption in quality rankings for most healthcare systems and might yield more-salient measures for tracking healthcare quality.
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.|Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.|Department of Geographical and Sustainability Sciences, College of Medicine, University of Iowa, Iowa City, Iowa.
authors.forename: Margaret
authors.initials: M
authors.lastname: Carrel
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania.|Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.affiliation: Division of General Internal Medicine, College of Medicine, University of Iowa, Iowa City, Iowa.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kaboli
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards; D011307:Drug Prescriptions / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D015994:Incidence; D008297:Male; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans; D058014:Veterans Health
keywords: medication safety; pharmacoepidemiology; pharmacotherapy; quality of care