A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program.
A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program.
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对两种实施策略进行整群随机试验，以在 EQUIPPED 药物安全计划中提供审核和反馈。
DOI：
10.1111/acem.14697
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
The EQUIPPEDVAImplementationQIGroup
中科院分区：
文献类型：
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作者：
Vaughan,CamilleP;Burningham,Zach;Kelleher,JessicaL;McGwin,Gerald;Jasien,ChristineL;Hastings,SNicole;Stevens,MelissaB;Morris,Isis;Jackson,GeorgeL;The EQUIPPEDVAImplementationQIGroup
目的提高急诊科出院老年人的处方质量（equip）药物安全项目包括三个核心组成部分，包括提供者教育、临床决策支持以及使用美国老年医学会比尔斯标准确定潜在不适当药物（PIMs）的审计和反馈。本研究通过集中的基于信息学的仪表板评估了审计和反馈的实施情况，并与equip冠军一对一交付的学术细节进行了比较。方法在一项集群随机研究（2019年10月- 2021年9月）中，8个VA急诊科（ed）对equip的审计和反馈部分实施了学术详细说明（n= 4）或仪表板（n= 4）策略。主要结果是65岁或65岁以上退伍军人在急诊科出院时每月处方pim的比例。使用泊松回归来评估在实施equip前6个月与实施后12个月规定的pim的比例。结果8个VA ED站点成功实施了equip计划。在6个月的基线期间，学术细节网站和仪表板网站的PIM处方率相似，学术细节网站为8.01%，仪表板网站为8.04% （p= 0.90）。比较装备实施后12个月的处方数据，与仪表板组（8.10%；优势比1.14,95%可信区间1.08-1.22,p≤0.0001）相比，学术详细组显著改善了PIM处方（7.07%）。在这些组中，四个学术详细站点中的两个显示统计上显着减少了PIM处方。四个仪表板站点中的一个实现了近50%的PIM处方相对减少。结论在COVID - 19大流行带来的前所未有的挑战中，seight VA EDs成功实施了装备计划的核心组成部分。虽然在小组层面上，对装备审计和反馈的学术详细方法在改善从急诊科出院的老年退伍军人的安全处方方面更为有效，但试验表明，在资源有限的情况下，基于仪表板的审计和反馈是一种合理的策略。
ObjectivesThe 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.MethodsIn 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.ResultsEight 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.ConclusionsEight 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.