Dual Use of Medications (DUAL) Partnered Evaluation Initiative

药物双重用途 (DUAL) 合作评估计划

• 批准号: 10181835
• 负责人: Walid F. Gellad
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181835
• 关键词: Academic Detailing; Address; Adoption; Adverse event; Agreement; Anticoagulants; Benzodiazepines; Calendar; Charge; Clinical; Clinical Pharmacists; Collaborations; Data; Data Analyses; Data Sources; Dose; Drug Interactions; Drug Targeting; Effectiveness; Elderly; Enrollment; Ensure; Evaluation; Focus Groups; Fostering; Funding; Future; Goals; Health; Health Insurance; Health Priorities; Health system; Healthcare Systems; Heart Diseases; Hypoglycemic Agents; Insurance Carriers; Insurance Coverage; Intervention; Interview; Learning; Malignant Neoplasms; Measurement; Medicare; Medication Systems; Mental disorders; Monitor; Opioid; Oral; Outcome; Outpatients; Patients; Pharmaceutical Preparations; Pharmacy Administration; Pharmacy facility; Physicians; Practical, Robust Implementation and Sustainability Model; Provider; Qualitative Methods; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Records; Research; Resources; Risk; Safety; Surveillance Program; System; Telephone Interviews; Time; United States Centers for Medicare and Medicaid Services; Variant; Veterans; Veterans Health Administration; Work; care coordination; clinical care; cost; dashboard; data integration; data sharing; design; effectiveness evaluation; effectiveness outcome; experience; health care service organization; high risk; implementation barriers; implementation facilitators; implementation outcomes; implementation science; improved; medication administration; medication safety; novel; novel therapeutics; opioid overdose; opioid use; opioid use disorder; pharmacy benefit; programs; tool

The VA Center for Medication Safety (VAMedSAFE) is charged with improving the safety of medication use for Veterans. VAMedSAFE’s interventions address the most serious, prevalent, and high-priority health conditions among Veterans, and yet they have a key limitation – they cannot account for medications received by Veterans outside VA. Over 80% of VA enrollees have access to medications through other forms of health insurance, including 50% with Medicare. There is strong evidence that receiving medications from multiple health systems poses serious health risks. The inability to integrate non-VA prescriptions into VA medication surveillance efforts has greatly diminished VA’s capacity to ensure safe prescribing to Veterans. Driven by this evidence, VA signed a groundbreaking agreement with the Centers for Medicare & Medicaid Services (CMS) to integrate CMS data on prescriptions filled by Veterans in Medicare into VAMedSAFE’s ongoing safety surveillance activities – something VA has never before been able to do. By the end of calendar year 2020, VAMedSAFE will have received and cleaned CMS data on dispensed Medicare prescriptions for all enrolled Veterans and will integrate these data into their ongoing medication surveillance activities. The objective of our proposed Dual Use of Medications (DUAL) Partnered Evaluation Initiative is to aid VAMedSAFE in developing and evaluating the roll-out of new quality enhancement tools using these combined CMS/VA data. Our evaluation has three aims, with the first aim split into two sub-aims. In Aim 1, we will work with VAMedSAFE to formatively evaluate the types of medications to prioritize when integrating CMS prescription data into their quality enhancement tools. Aim 1a will quantify how the integration of CMS prescription data could impact exposure measurement (e.g., number of patients identified as incident medication users) and outcomes (e.g., number of patients with a medication-related adverse event) for each ongoing VAMedSAFE surveillance program. Aim 1b will identify high-impact targets for new VA drug safety initiatives using CMS/VA data, using both quantitative and qualitative analyses. We will query the CMS/VA data to identify broad drug classes (e.g., hypoglycemics, opioids) that are frequently duplicated or overlapping between CMS and VA. Then, we will convene two interdisciplinary focus groups with key stakeholders to identify additional potential high-impact drug targets for future interventions using the CMS/VA data. In Aim 2, we will evaluate end users’ experiences with the first integration of CMS data into a VAMedSAFE drug safety dashboard focusing on direct-acting oral anticoagulant safety. Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we will conduct telephone interviews with end users of the dashboard (e.g., pharmacy directors, academic detailers, clinicians) to identify implementation barriers and facilitators and learn about their experiences receiving the data, how it impacts clinical care, and whether CMS data integration leads to unintended consequences. Finally, in Aim 3, we will partner with VAMedSAFE to design and deploy a stepped-wedge randomized evaluation of a 2nd drug safety dashboard using integrated CMS and VA data, using findings from Aims 1 and 2 to identify the optimal drug target and implementation support. We will use RE-AIM as a framework for examining effectiveness (e.g., drug discontinuation, adverse events) and implementation (e.g. reach, adoption) outcomes. These new data provide an unprecedented opportunity to strengthen VA medication safety surveillance for Veterans who receive medications through Medicare. This evaluation was requested and is co-funded by VAMedSAFE, which requires a non-research partnership, as the CMS/VA data can only be used for quality improvement. This project aligns with VA QUERI priorities to apply implementation science to real-world practices, use novel data sources for quality improvement, and help program offices build data capacity and evaluate new quality enhancement tools.

VA药物安全中心（VAMedSAFE）负责提高药物使用的安全性， 老兵VAMedSAFE的干预措施针对最严重、最普遍和最优先的健康状况 然而，他们有一个关键的限制-他们不能解释接受的药物， 退伍军人在外面。超过80%的VA注册者通过其他形式的健康获得药物 医疗保险，包括50%的医疗保险。有强有力的证据表明，接受多种药物治疗， 卫生系统构成严重的健康风险。无法将非VA处方整合到VA药物中 监视工作大大削弱了退伍军人管理局确保退伍军人安全处方的能力。 在这一证据的推动下，弗吉尼亚州与医疗保险和医疗补助中心签署了一项开创性的协议。 服务（CMS）将CMS关于退伍军人在Medicare中填写的处方的数据集成到VAMedSAFE的 正在进行的安全监督活动-这是退伍军人事务部以前从未能够做到的。在日历结束时 到2020年，VAMedSAFE将接收并清理所有已分配医疗保险处方的CMS数据 招募退伍军人，并将这些数据整合到他们正在进行的药物监测活动。 我们提出的双重使用药物（DUAL）合作评估倡议的目标是帮助 VAMedSAFE在开发和评估新的质量增强工具的推出时使用这些组合 CMS/VA数据。我们的评估有三个目标，第一个目标分为两个子目标。在目标1中，我们将 与VAMedSAFE一起形成性地评估在整合CMS时优先考虑的药物类型 处方数据到他们的质量提升工具中。目标1a将量化如何整合CMS 处方数据可能影响暴露测量（例如，确定为事件的患者数量 药物使用者）和结果（例如，发生药物相关不良事件的患者数量） 正在进行的VAMedSAFE监视计划。目标1b将确定新VA药物安全性的高影响目标 使用CMS/VA数据，使用定量和定性分析。我们将查询CMS/VA 用于识别广泛药物类别的数据（例如，降糖药，阿片类药物），经常重复或重叠 CMS和VA之间。然后，我们将与主要利益相关者召开两个跨学科焦点小组会议， 使用CMS/VA数据确定未来干预措施的其他潜在高影响药物目标。在目标2中， 我们将评估最终用户首次将CMS数据集成到VAMedSAFE药物安全系统中的体验 仪表板侧重于直接作用口服抗凝剂的安全性。以实用、稳健的实施为指导 和可持续发展模型（PRISM），我们将对仪表板的最终用户进行电话采访（例如， 药房主任，学术细节，临床医生），以确定实施障碍和促进因素，并学习 关于他们接收数据的经历，它如何影响临床护理，以及CMS数据集成是否 导致了意想不到的后果。最后，在目标3中，我们将与VAMedSAFE合作设计和部署 使用整合CMS和VA数据对第二个药物安全性仪表板进行阶梯楔形随机化评价， 利用目标1和2的研究结果，确定最佳药物目标和实施支持。我们将使用 RE-AIM作为检查有效性的框架（例如，停药、不良事件）和 实施（例如覆盖面、采用）成果。 这些新数据为加强VA药物安全性监测提供了前所未有的机会， 通过医疗保险接受药物治疗的退伍军人。这项评价是应要求进行的，并由以下方面共同供资： VAMedSAFE，需要非研究合作伙伴关系，因为CMS/VA数据只能用于质量 改进.该项目与VA QUERI的优先事项相一致，将实施科学应用于现实世界 实践，使用新的数据源进行质量改进，并帮助计划办公室建立数据能力， 评估新的质量改进工具。