title: Development of the Tool to Reduce Inappropriate Medications (TRIM): A Clinical Decision Support System to Improve Medication Prescribing for Older Adults.
abstract: To create a clinical decision support system (CDSS) for evaluating problems with medications among older outpatients based on a broad set of criteria.
  
  
  
  Web-based CDSS development.
  
  
  
  Primary care clinics at a Veterans Affairs medical center.
  
  
  
  Forty veterans 65 years and older who were prescribed seven or more medications that included those for treatment of diabetes mellitus and hypertension.
  
  
  
  The Tool to Reduce Inappropriate Medications (TRIM) uses a program to extract age, medications, and chronic conditions from the electronic health record to identify high-risk patients and as input for evaluating the medication regimen. Additional health variables obtained through chart review and direct patient assessment are entered into a Web-based program. Based on a series of algorithms, TRIM generates feedback reports for clinicians. TRIM identified medication reconciliation discrepancies in 98% (39/40) of veterans, potentially inappropriate medications in 58% (23/40), potential problems with feasibility (based on poor adherence and/or cognitive impairment) in 25% (10/40), potential overtreatment of hypertension in 50% (20/40), potential overtreatment of diabetes in 43% (17/40), inappropriate dosing of renally excreted medications in 5% (2/40), and patient-reported adverse reactions in 5% (2/40).
  
  
  
  This evaluation of TRIM demonstrated that data elements can be extracted from the electronic health record to identify older primary care patients at risk for potentially problematic medication regimens. Supplemented with chart review and direct patient assessment, these data can be processed through clinical algorithms that identify potential problems and generate patient-specific feedback reports. Additional work is necessary to assess the effects of TRIM on medication deprescribing.
authors.affiliation: Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Niehoff
authors.affiliation: Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Nallakkandi
authors.initials: N
authors.lastname: Rajeevan
authors.affiliation: Program on Aging, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Charpentier
authors.affiliation: Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut.|Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Perry L
authors.initials: PL
authors.lastname: Miller
authors.affiliation: Palo Alto Geriatrics Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, California.|Department of Medicine (Center for Primary Care and Outcomes Research), Stanford University, Stanford, California.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
authors.affiliation: Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Terri R
authors.identifier: 0000-0001-8083-8265
authors.initials: TR
authors.lastname: Fried
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002908:Chronic Disease; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D019338:Polypharmacy
keywords: computer technology; evidence-based medicine; geriatrics; polypharmacy