Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED

NCT04004936 | Completed Results

• 2 other identifiers: IIR 17-236IIR HX00257-01A1
• Study Type: interventional
• Target: 74
• Locations: 1 country
• Sites: 4

Brief Summary

This research is being conducted to learn which implementation strategy of EQUIPPED is most effective to improve prescribing practices of ED providers toward older Veterans and determine the factors influencing implementation of this program to reduce the prescribing of PIMs to older adults upon discharge from the ED. The study has three research aims. The procedures for these research aims are described below:

• Aim 1 - Examining the Impact of Passive Provider Feedback vs. Active Provider Feedback Through a Randomized Trial
• Aim 2 - Determination of Factors Affecting Organizational Adoption of EQUIPPED
• Aim 3 - Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention

Conditions

Aging

Keywords

Emergency Department; Potentially Inappropriate Medications; Inappropriate Prescribing; Quality Improvement; Veteran Health; Older Adults

Outcome Measures

Primary Outcomes (1)

• Percentage of PIMs Prescribed

  Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED.

  12-Months Post Implementation of EQUIPPED

Secondary Outcomes (2)

• Social Cognitive Theory Survey - Perceived Control Domain

  12-Months After the Delivery of the First EQUIPPED Report

• Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention

  12-Months Post Implementation of EQUIPPED

Study Arms (2)

Active Feedback

ACTIVE COMPARATOR

EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.

Other: EQUIPPED with Active Feedback

Passive Feedback

ACTIVE COMPARATOR

EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.

Other: EQUIPPED with Passive Feedback

Interventions

EQUIPPED with Passive Feedback OTHER

Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.

Passive Feedback

EQUIPPED with Active Feedback OTHER

Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.

Active Feedback

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Prescribers at VA Medical Centers that are implementing EQUIPPED
• Members of the EQUIPPED implementation team at enrolled sites

You may not qualify if:

• Providers at VA Medical Centers that are not part of the upcoming EQUIPPED implementation trial.

Sponsors & Collaborators

• VA Office of Research and Development: lead
• Durham VA Health Care System: collaborator
• VA Salt Lake City Health Care System: collaborator
• Birmingham, Alabama VA Medical Center: collaborator

Study Sites (4)

Birmingham VA Medical Center, Birmingham, AL

Birmingham, Alabama, 35233-1927, United States

Location

Atlanta VA Medical and Rehab Center, Decatur, GA

Decatur, Georgia, 30033-4004, United States

Location

Durham VA Medical Center, Durham, NC

Durham, North Carolina, 27705-3875, United States

Location

VA Salt Lake City Health Care System, Salt Lake City, UT

Salt Lake City, Utah, 84148-0001, United States

Location

Related Publications (3)

• Burningham Z, Jackson GL, Kelleher J, Stevens M, Morris I, Cohen J, Maloney G, Vaughan CP. The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED? Clin Ther. 2020 Apr;42(4):573-582. doi: 10.1016/j.clinthera.2020.02.013. Epub 2020 Mar 25.

  PMID: 32222360 RESULT

• Burningham Z, Jackson GL, Kelleher JL, Morris I, Stevens MB, Cohen J, Maloney G, Sauer BC, Halwani AS, Chen W, Vaughan CP. Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics. Appl Clin Inform. 2023 Aug;14(4):684-692. doi: 10.1055/s-0043-1771393. Epub 2023 Aug 30.

  PMID: 37648222 RESULT

• Vaughan CP, Burningham Z, Kelleher JL, McGwin G, Jasien CL, Hastings SN, Stevens MB, Morris I, Jackson GL; The EQUIPPED VA Implementation QI Group. A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program. Acad Emerg Med. 2023 Apr;30(4):340-348. doi: 10.1111/acem.14697. Epub 2023 Mar 8.

  PMID: 36790188 RESULT

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Results Point of Contact

• Title: Dr. Elizabeth Camille Vaughan/ Atlanta Site Section Chief Birmingham/Atlanta GRECC
• Organization: Atlanta VAHCS

elizabeth.vaughan2@va.gov

404 315 4100

Study Officials

• Elizabeth Camille Vaughan, MD MS

  Atlanta VA Medical and Rehab Center, Decatur, GA

  PRINCIPAL INVESTIGATOR

• George Lee Jackson, PhD MHA

  Durham VA Medical Center, Durham, NC

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: In order to inform a Veterans Affairs (VA) system-wide approach to improve prescribing safety for older Veterans, the investigators will conduct a randomized study to determine best practices for influencing provider prescribing behavior in order to decrease PIMs prescribed for older Veterans at the time of ED discharge. The overall goal of this project is to determine which EQUIPPED implementation strategy (active or passive feedback) is most effective to reduce prescribing of PIMs for older Veterans discharged from the ED. Eight sites will be randomized to either active feedback with individual, in-person academic detailing or passive feedback delivered via an individualized electronic dashboard.

Study Record Dates

• First Submitted: June 28, 2019
• First Posted: July 2, 2019
• Study Start: October 1, 2019
• Primary Completion: December 31, 2022
• Study Completion: December 31, 2024
• Last Updated: February 25, 2026
• Results First Posted: August 6, 2024

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (4)