Optimizing Appropriate Use of Medications for Veterans

优化退伍军人药物的合理使用

• 批准号: 10200823
• 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
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200823
• 关键词: Address; Area; Caring; Categories; Characteristics; Chronic Kidney Failure; Clinic; Clinical; Community of Practice; Complement; Costs and Benefits; Data; Development; Diabetes Mellitus; Disease; Drug Prescriptions; Effectiveness; Environment; Evaluation; Fostering; General Population; Goals; Health system; Healthcare; Heart failure; Home; Hospitals; Hyperlipidemia; Incidence; Information Technology; Infrastructure; Institute of Medicine (U.S.); Intervention; Medication Management; Methods; Methotrexate; Mineralocorticoid Receptor; Monitor; Morbidity - disease rate; Natural experiment; Patient Care; Patient Monitoring; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Positioning Attribute; Primary Health Care; Process; Provider; Qualitative Methods; Recommendation; Recording of previous events; Resources; Safety; Structure; Sulfasalazine; Testing; Variant; Veterans; Work; base; care systems; clinical care; clinical decision support; clinical decision-making; clinical implementation; clinical practice; compare effectiveness; cost; dashboard; design; effectiveness evaluation; formative assessment; functional status; graphical user interface; high risk; hypertension control; implementation facilitators; implementation science; implementation strategy; improved; innovation; learning progression; medical specialties; medication safety; operation; pharmacy benefit; programs; provider networks; randomized trial; satisfaction; support network; support tools; therapy design

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.

我们选择优化药物使用作为 QUERI 计划的主题，并做出决定 支持和提供者网络作为实施的重点。我们的建议将建立在现有的强大 项目负责人之间的关系（拥有成功开展 QUERI 项目的悠久历史）， 以及我们的运营合作伙伴，包括药房福利管理 (PBM)、初级保健 (PC) 和 专业护理服务。 主要计划目标：优化 VA 一般和患者协调护理中的药物管理 特别是使用药房网络和决策支持工具的团队。 虽然 VA 实施了许多干预措施来提高用药安全，但药物管理 巨大的改进空间。医学研究所提出的几项建议，包括广泛的 决策支持的可用性和更多药房参与处方尚未广泛 在弗吉尼亚州实施。 2011 年，12% 的退伍军人服用了可能不适当的药物 每年发生率（新的不适当药物）为 6%。药品质量差异较大 VA 中已指出处方与一般人群相当。也存在差异 退伍军人管理局跨疾病状态的处方质量。 相关目标：价值：我们的基本原则是促进所有药物的高价值临床护理 相关干预措施。我们只会建议扩展护理策略或设计干预措施 被认为是“合理”值（效益与成本之比）。我们计划提高高价值的利用 通过以下方式减少低价值药物的使用并提高用药安全性： 1）PBM的药物使用评估跟踪器（MUET）的优化和扩展。 （项目1） 2) 对 PC 中常用处方药物实施临床决策支持。 （项目2） 3) 当地一年期项目：确定针对患者的 VISN 21 药房仪表板的最佳使用方式 协调一致的护理团队。 （项目3） 这些项目包括创新（临床决策支持、实践社区的使用、开发 新的药物使用评估跟踪器）和现有实施实践的评估。通过采取 不同设施实施 MUET 计划时所进行的自然实验的优势 与 VISN 21 Pharmacy Dashboard 不同的是，我们将能够检查各种药物的有效性和价值 的实施策略。 实施科学重点：我们选择的实施重点领域是提供商的使用 网络。正如下面实施核心部分所述，通过我们之前的 QUERI 工作，我们已经 （在一项随机试验中）显示了 QUERI 促进提供商网络如何成功推出 退伍军人管理局卫生系统的国家倡议（医院到家庭）。我们的结果表明，提供商网络 可以补充自上而下的实施策略，以改善对退伍军人的护理。这样的网络是一个 未实现的改善护理的机会，而退伍军人管理局在开发和利用这些机会方面具有独特的优势。 QUERI 计划的长期目标是利用本地资源优化基础设施和实施策略 提供者（项目 1 中的药剂师）、临床决策支持（项目 2）和仪表板数据（项目 3） 可用于药物管理之外的各种临床决策，例如诱导患者 患有多种疾病的患者的护理或监测功能状态的目标。因此，虽然我们的程序 直接适用于药物管理，开发和测试的方法广泛适用于 VA 医疗保健 并解决 VA 卓越蓝图的重点是利用信息技术和分析，同时 营造持续学习的环境。