Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014;35(4):395-408.
doi: 10.1080/02701960.2014.907159. Epub 2014 Jun 5.

Combining quality improvement and geriatrics training: the nursing home polypharmacy outcomes project

Gotaro Kojima  1 , Christina L Bell, Bruce Tamura, James Davis, Michiko Inaba, Pia Lorenzo, Patricia Lanoie Blanchette, Wendy Iwasaki, Kamal Masaki
Affiliations

Combining quality improvement and geriatrics training: the nursing home polypharmacy outcomes project

Gotaro Kojima et al. Gerontol Geriatr Educ. 2014.

Abstract

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.

Keywords: geriatric education; geriatric medicine fellowship; nursing homes; polypharmacy; quality improvement.

PubMed Disclaimer

References

    1. ACGME. ACGME Program Requirements for Graduate Medical Education in Geriatric Medicine. The Accreditation Council for Graduate Medical Education; 2011. ACGME. (2005, 7/1/2011) Retrieved December 8, 2012, from http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/151....
    1. Audet AM, Doty MM, Shamasdin J, Schoenbaum SC. Measure, learn, and improve: physicians’ involvement in quality improvement. Health Aff (Millwood) 2005;24(3):843–853. - PubMed
    1. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151(9):1825–1832. - PubMed
    1. Brennan TA. Physicians’ professional responsibility to improve the quality of care. Acad Med. 2002;77(10):973–980. - PubMed
    1. Dallenbach MF, Bovier PA, Desmeules J. Detecting drug interactions using personal digital assistants in an out-patient clinic. QJM. 2007;100(11):691–697. - PubMed

Publication types

LinkOut - more resources