权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Optimizing Appropriate Use of Medications for Veterans

优化退伍军人药物的合理使用

基本信息

批准号：
9205392
负责人：
MARY K. Goldstein
金额：
--
依托单位：
VETERANS ADMIN PALO ALTO HEALTH CARE SYS
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-10-01 至 2021-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9205392
关键词：
Address Address Area Area Caring Caring Categories Categories Characteristics Characteristics Chronic Kidney Failure Chronic Kidney Failure Clinic Clinic Clinical Clinical Community Practice Community of Practice Community of Practice Complement Complement Costs and Benefits Costs and Benefits Data Data Development Development Diabetes Mellitus Diabetes Mellitus Disease Disease Effectiveness Effectiveness Environment Environment Evaluation Evaluation Fostering Fostering General Population General Population Goals Goals Health system Health system Healthcare Healthcare Heart failure Heart failure Home environment Home environment Hospitals Hospitals Hyperlipidemia Hyperlipidemia Hypertension Incidence Incidence Information Technology Information Technology Infrastructure Institute of Medicine (U.S.)Institute of Medicine (U.S.)Intervention Intervention Medication Management Medication Management Methods Methods Methotrexate Methotrexate Mineralocorticoid Receptor Mineralocorticoid Receptor Monitor Monitor Morbidity - disease rate Morbidity - disease rate Natural experiment Natural experiment Patient Care Patient Care Patient Monitoring Patient Monitoring Patients Patients Pharmaceutical Preparations Pharmaceutical Preparations Pharmacists Pharmacists Pharmacy facility Pharmacy facility Positioning Attribute Positioning Attribute Primary Health Care Primary Health Care Process Process Provider Provider Qualitative Methods Qualitative Methods Recommendation Recommendation Recording of previous events Recording of previous events Research Infrastructure Resources Resources Safety Safety Services Structure Structure Sulfasalazine Sulfasalazine Testing Testing Variant Variant Veterans Veterans Work Work base base care systems clinical care clinical care clinical decision support clinical decision-making clinical decision-making clinical implementation clinical practice clinical practice compare effectiveness compare effectiveness cost cost dashboard dashboard design design effectiveness evaluation formative assessment formative assessment functional status functional status graphical user interface graphical user interface high risk high risk hypertension control implementation science implementation science implementation strategy improved improved innovation innovation learning progression learning progression medical specialties medical specialties medication safety operation operation pharmacy benefit pharmacy benefit programs programs provider networks randomized trial randomized trial satisfaction satisfaction support network support tools support tools therapy design therapy design

项目摘要

We have selected optimization of medication use as the main theme of our QUERI Program with decision support and provider networks as foci of implementation. Our proposal will build upon existing strong relationships between the project leads (who have a long history of conducting successful QUERI projects), and our operations partners including Pharmacy Benefits Management (PBM), Primary Care (PC), and Specialty Care Services. Primary Program Goal: To optimize medication management in the VA general and Patient Aligned Care Teams in particular using pharmacy networks and decision support tools. While the VA has implemented many interventions to improve medication safety, medication management has significant room for improvement. Several recommendations by the Institute of Medicine, including the wide availability of decision support and more pharmacy involvement in prescribing have not been widely implemented in the VA. In 2011, 12% of Veterans were prescribed a potentially inappropriate medication with an incidence (new inappropriate medication) of 6% per year. A large variation in the quality of medication prescribing has been noted in the VA which is comparable to the general population. There is also variation in quality of prescribing across disease states in the VA. Associated Goal: Value: Our underlying principle is to promote high value clinical care with all medication related interventions. We will only recommend expansion of, or design interventions for, care strategies that are considered a “reasonable” value (ratio of benefit and cost). We plan to improve use of high value medications, decrease use of low-value medications and improve medication safety through: 1) Optimization and expansion of the Medication Use Evaluation Tracker (MUET) of PBM. (Project 1) 2) Implementation of Clinical Decision Support for medications commonly prescribed in PC. (Project 2) 3) Local One-Year Project: Determine optimal use of the VISN 21 Pharmacy Dashboard targeting Patient Aligned Care Teams. (Project 3) These projects include both innovation (clinical decision support, use of communities of practice, development of a new Medication Use Evaluation Tracker) and evaluation of existing implementation practices. By taking advantage of natural experiments that have occurred as different facilities implemented the MUET program and VISN 21 Pharmacy Dashboard differently, we will be able to examine effectiveness and value of a variety of implementation strategies. Implementation Science Focus: Our chosen area of focus for implementation is the use of provider networks. As described below in the Implementation Core Section, through our prior QUERI work we have shown (in a randomized trial) how QUERI facilitation of a provider network can be successful in rolling out a national initiative (Hospital to Home) in the VA health system. Our results demonstrate that Provider networks can complement top down implementation strategies to improve care for Veterans. Such networks are an unrealized opportunity to improve care, and the VA is uniquely positioned to develop and use them. A long-term goal of the QUERI Program is to optimize infrastructure and implementation strategies using local providers (pharmacists in Project 1), clinical decision support (Project 2) and, dashboard data (Project 3) that can be used for a variety of clinical decisions beyond medication management such as elicitation of patient goals of care or monitoring functional status in patients with multiple morbidities. Thus, while our program applies directly to medication management, the methods developed and tested apply broadly to VA health care and address VA's Blueprint for Excellence's focus on leveraging information technologies and analytics while fostering an environment of continuous learning.

我们选择药物使用优化作为我们的QUERI项目的主题与决策