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Enhancing Quality of Provider Practices for Older Adults in the Emergency Department ( EQU i PPED )
Author(s) -
Stevens Melissa,
Hastings Susan N.,
Markland Alayne D.,
Hwang Ula,
Hung William,
Vandenberg Ann E.,
Bryan William,
Cross Dewayne,
Powers James,
McGwin Gerald,
Fattouh Noor,
Ho William,
Clevenger Carolyn,
Vaughan Camille P.
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14890
Subject(s) - medicine , emergency department , veterans affairs , geriatrics , intervention (counseling) , beers criteria , poisson regression , timeline , emergency medicine , medical prescription , quality management , medical emergency , family medicine , gerontology , nursing , environmental health , population , psychiatry , management system , archaeology , management , economics , history
EQU i PPED is a multicomponent quality improvement initiative combining education, electronic clinical decision support, and individual provider feedback to influence prescribing and improve medication safety for older adults. The objective here was to evaluate the effectiveness and sustainability of EQU i PPED to reduce the use of potentially inappropriate medications ( PIM s), as defined by the American Geriatrics Society 2012 Beers Criteria, prescribed to older Veterans at the time of emergency department ( ED ) discharge. This evaluation represents a pre‐ and post‐intervention comparison of PIM prescriptions at 4 urban Veteran Affairs ( VA ) Medical Center ED s. Poisson regression was used to compare the number of PIM s prescribed to Veterans 65 years or older discharged from the ED for at least 6 months prior to the first EQU i PPED intervention at each site and for at least 12 months following the final EQU i PPED intervention. The implementation timeline varied by site depending on local resources. All 4 sites showed a significant and sustained reduction in use of PIM s. The proportion of PIM s at site one decreased from 11.9% ( SD 1.8) pre‐ EQU i PPED to 5.1% ( SD 1.4) post‐ EQU i PPED ( P < .0001); site 2 from 8.2% ( SD 0.8) pre to 4.5% ( SD 1.0) post ( P < .0001); site 3 from 8.9% ( SD 1.9) pre to 6.1% ( SD 1.7) post ( P = .0007); and site 4 from 7.4% ( SD 1.7) pre to 5.7% ( SD 0.8) post ( P = .04). These results suggest a multicomponent program to influence provider prescribing behavior leads to safer prescribing for older adults discharged from the ED and is sustainable across multiple VA ED sites.