Evaluating a Prescribing Feedback System for Acute Care Providers

评估急性护理提供者的处方反馈系统

• 批准号: 10515631
• 负责人: MICHAEL E. MATHENY
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10515631
• 关键词: Academic Detailing; Academic Medical Centers; Accident and Emergency department; Acute; Address; Adverse drug event; Adverse event; Advisory Committees; Ambulatory Care; Antibiotics; Behavior; Calibration; Cardiovascular system; Caring; Clinic; Complex; Consolidated Framework for Implementation Research; Coupled; Data; Development; Drug Interactions; Drug Prescriptions; Education; Educational workshop; Elderly; Electronics; Emergency Care; Engineering; Environment; Evaluation; Familiarity; Feedback; Future; Goals; Guidelines; Health; Healthcare; Healthcare Systems; Human; Ibuprofen; Incentives; Individual; Informatics; Inpatients; Institution; Intervention; Interview; Intuition; Joints; Kidney; Knowledge; Learning; Machine Learning; Methods; Musculoskeletal Pain; Non-Steroidal Anti-Inflammatory Agents; Operations Research; Outcome; Outpatients; Pain; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Planning Theory; Prevention; Primary Care; Process; Provider; Qualifying; Qualitative Methods; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Registries; Research; Risk; Risk Adjustment; Safety; Sampling; Site; Source; Structure; System; Tennessee; Vacuum; Variant; Veterans; Veterans Health Administration; Visit; Visual; Writing; acute care; antimicrobial; behavior change; care delivery; care providers; clinical center; comorbidity; cost; design; effectiveness evaluation; experience; field study; gastrointestinal; health care service utilization; hybrid type 1 design; iatrogenic injury; implementation intervention; implementation outcomes; implementation science; implementation strategy; improved; innovation; medication safety; multi-component intervention; patient safety; prescription opioid; pressure; prevent; primary care clinic; primary care setting; primary care visit; programs; risk prediction model; satisfaction; therapy design; tool; uptake; urgent care; user centered design

No systematic, automated process for providing feedback to acute care providers exists in the Veterans Health Administration (VHA), despite there being 432,000 acute care visits annually by Veterans seeking acute care via the emergency department (ED), urgent care clinics, or primary care clinics in the VHA. More than 144 million prescriptions are written in these VHA acute care settings each year, many for antibiotics or non-steroidal anti-inflammatory drugs (NSAIDs). More than 30% of acute care prescriptions for antibiotics or NSAIDs are inappropriate and carry associated increased risk of adverse drug events (ADEs) due to lack of patient or comorbidity familiarity, drug-drug interactions, and patient pressure to prescribe. Currently, acute outpatient care providers operate without knowledge of their own prescribing quality or patient outcomes. This absence of feedback creates a vacuum through which providers may falsely assume a positive outcome. Inadequate outcomes feedback and understanding of indications and contraindications to prescribing antibiotics and NSAIDs have hindered improvement in the quality and safety of prescriptions for Veteran in acute care settings. We will use user-centered design to develop a scalable prescribing feedback system that includes audit and feedback, academic detailing, and non-financial incentives, will be implemented to examine how this multifaceted intervention impacts potentially inappropriate prescribing and ADEs in acute outpatient care settings in the VHA. This project describes a mixed-methods proposal that addresses major HSR&D priorities to improve Veteran health and advance the VHA as a learning healthcare system. The Specific Aims are: 1) Evaluate determinants of potentially inappropriate prescribing to design intervention implementation in acute outpatient care settings.; 2) Develop and evaluate a risk-adjusted provider profiling surveillance system; 3) Refine the visual representation of the feedback system with user-centered design; and 4) Examine the impact of implementation of a multifaceted intervention on potentially inappropriate prescriptions and ADEs. The team is uniquely qualified to accomplish these aims, with expertise in healthcare operations research, informatics, human factors engineering and user-centered design, implementation science, qualitative methods, and practicing clinicians in acute care settings (emergency department and primary care). The institutional environment at the VA Tennessee Valley Healthcare System and Vanderbilt University Medical Center is outstanding, including the Geriatric Research, Education and Clinical Center (GRECC), a site for VA Quality Scholars, an innovative qualitative research center; nationally ranked graduate programs in the relevant fields of study; and the national CTSA coordinating center. This application will develop an automated feedback system for acute care providers using antibiotic and NSAID prescribing as two exemplars of the need for acute care provider feedback in the VHA. Taking a user- centered approach by placing the provider at the center of the design process will substantially advance the ability to enhance provider activities through the delivery of scalable feedback using Veteran, provider, and stakeholder input. Advancing the delivery of acute outpatient provider feedback creates a mechanism to improve provider quality and safety, and ultimately to enhance Veteran health.

在退伍军人健康中，没有系统的、自动化的流程来向急性护理提供者提供反馈。 管理局（VHA），尽管每年有432，000次退伍军人寻求急性护理访问， 通过VHA的急诊科（艾德）、紧急护理诊所或初级护理诊所进行护理。更 每年有超过1.44亿张处方在这些VHA急性护理机构中开出，其中许多是抗生素或 非甾体抗炎药（NSAIDs）。超过30%的急性护理处方用于抗生素 或NSAID是不合适的，并且由于缺乏药物， 患者或合并症的熟悉程度，药物相互作用，以及患者开药的压力。目前，急性 门诊护理提供者在不了解他们自己的处方质量或患者结果的情况下操作。这 缺乏反馈会造成一种真空，使提供者可能错误地认为会有积极的结果。 结果反馈和对处方适应症和禁忌症的理解不足 抗生素和非甾体抗炎药阻碍了退伍军人处方质量和安全性的提高， 急性护理环境。我们将使用以用户为中心的设计来开发一个可扩展的处方反馈系统， 包括审计和反馈，学术细节和非经济激励，将被实施，以检查 这种多方面的干预如何影响急性门诊患者的潜在不当处方和ADE VHA中的护理设置。 该项目描述了一个混合方法的建议，解决主要的HSR&D的优先事项，以改善退伍军人 健康和推进VHA作为一个学习的医疗保健系统。具体目标是：（1）评估 在急性门诊患者中设计实施干预措施的潜在不适当处方的决定因素 护理环境。2)开发和评估风险调整后的供应商分析监督系统; 3）完善 以用户为中心的设计的反馈系统的视觉表示;和4）检查的影响 对可能不适当的处方和ADE实施多方面干预。 该团队是唯一有资格实现这些目标，在医疗保健业务研究的专业知识， 信息学，人因工程和以用户为中心的设计，实施科学，定性 方法，并在急性护理环境（急诊科和初级保健）执业临床医生。的 弗吉尼亚州田纳西河谷医疗保健系统和范德比尔特大学医学院的机构环境 中心是杰出的，包括老年研究，教育和临床中心（GRECC），一个网站的VA 质量学者，一个创新的定性研究中心;在全国排名研究生课程 相关研究领域;和国家CTSA协调中心。 该应用程序将为使用抗生素的急性护理提供者开发自动反馈系统， NSAID处方作为VHA中需要急性护理提供者反馈的两个范例。把一个用户- 通过将供应商置于设计过程的中心， 能够通过使用Veteran、Provider和 利益攸关方的投入。推进急性门诊提供者反馈的交付创建了一个机制， 提高供应商的质量和安全，并最终提高退伍军人的健康。