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Randomized Controlled Trial
. 2023 Apr;30(4):340-348.
doi: 10.1111/acem.14697. Epub 2023 Mar 8.

A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program

Camille P Vaughan  1   2 , Zach Burningham  3   4 , Jessica L Kelleher  5 , Gerald McGwin  1   6 , Christine L Jasien  5 , S Nicole Hastings  7   8 , Melissa B Stevens  1   9 , Isis Morris  8 , George L Jackson  8   10   11 ; The EQUIPPED VA Implementation QI Group
Collaborators, Affiliations
Free article
Randomized Controlled Trial

A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program

Camille P Vaughan et al. Acad Emerg Med. 2023 Apr.
Free article

Abstract

Objectives: The Enhancing the Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) medication safety program involves three core components including provider education, clinical decision support, and audit and feedback using the American Geriatrics Society Beers Criteria to determine potentially inappropriate medications (PIMs). This study evaluated implementation of audit and feedback through a centralized informatics-based dashboard compared to academic detailing delivered one on one by an EQUIPPED champion.

Methods: In a cluster-randomized study (October 2019-September 2021), eight VA emergency department (EDs) implemented either the academic detailing (n = 4) or the dashboard (n = 4) strategy for the audit and feedback component of EQUIPPED. The primary outcome was the monthly proportion of PIMs prescribed to Veterans 65 years or older at ED discharge. Poisson regression was used to evaluate the proportion of PIMs prescribed 6 months prior to EQUIPPED implementation compared to 12 months following implementation.

Results: Eight VA ED sites successfully implemented the EQUIPPED program. During the 6-month baseline period, the academic detailing and dashboard sites had similar PIM prescribing rates of 8.01% for academic detailing versus 8.04% for dashboard (p = 0.90). Comparing 12 months of prescribing data after EQUIPPED implementation, the academic detailing group significantly improved PIM prescribing (7.07%) compared to the dashboard group (8.10%; odds ratio 1.14, 95% confidence interval 1.08-1.22, p ≤ 0.0001). Within the groups, two of the four academic detailing sites demonstrated statistically significant reductions in PIM prescribing. One of the four dashboard sites achieved nearly 50% relative reduction in PIM prescribing.

Conclusions: Eight VA EDs successfully implemented the core components of the EQUIPPED program amid the unprecedented challenges posed by the COVID-19 pandemic. While the academic detailing approach to EQUIPPED audit and feedback was more effective at the group level to improve safe prescribing for older Veterans discharged from the ED, the trial suggests that dashboard-based audit and feedback is a reasonable strategy in resource-limited settings.

Keywords: academic detailing; aging; audit and feedback; clinical decision support; emergency department; medication safety.

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References

REFERENCES

    1. Stevens MB, Hastings SN, Powers J, et al. Enhancing the quality of prescribing practices for older veterans discharged from the emergency department: preliminary results from EQUIPPED, a novel multicomponent interdisciplinary quality improvement initiative. J Am Geriatr Soc. 2015;63:1025-1029.
    1. Stevens M, Hastings SN, Markland AD, et al. Enhancing quality of provider practices for older adults in the emergency department (EQUiPPED). J Am Geriatr Soc. 2017;65:1609-1614.
    1. Moss JM, Bryan WE 3rd, Wilkerson LM, et al. Impact of clinical pharmacy specialists on the design and implementation of a quality improvement initiative to decrease inappropriate medications in a veterans affairs emergency department. J Manag Care Spec Pharm. 2016;22:74-80.
    1. Vaughan CP, Hwang U, Vandenberg AE, et al. Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme. BMJ Open Qual. 2021;10(4):e001369.
    1. Goldberg EM, Lin TR, Cunha CB, Mujahid N, Davoodi NM, Vaughan CP. Enhancing the quality of prescribing practices for older adults discharged from the emergency department in Rhode Island. J Am Geriatr Soc. 2022;70:2905-2914.

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