E.Q.U.I.P.P.E.D.

 描述（由申请人提供）：老年人艾德（提高急诊科出院老年人处方实践的质量）老年人是药物不良事件（ADE）高风险的弱势人群，尤其是在他们从急诊科（艾德）出院时。最近的研究发现，超过一半的老年人出院的艾德离开一个新的处方药。在老年初级保健环境之外为老年患者开具新药会增加次优处方和ADE的机会，这两种情况都是重复艾德就诊、住院或死亡的主要原因1，2 2-8。一个全系统的方法，以提高老年人在艾德出院时的安全性是本提案的重点。 配备（提高从急诊科出院的老年人处方实践的质量）是一项创新的质量改进计划，旨在减少在ED设置中对65岁及以上成年人的潜在不适当药物处方。EMPED包括三项干预措施，所有干预措施都涉及AHRQ推广的患者安全研究框架：a）通过教学教育和期刊俱乐部进行提供者教育; B）通过专门的老年药物处方集和处方点在线教育内容链接的电子临床决策支持;以及c）学术细节，包括审计和反馈以及同行基准。Beers标准被政府机构广泛使用，并得到各种环境研究的支持1，6-7作为处方质量的标志。目前，在沃恩和史蒂文斯博士以及包括老年病学家、急诊医学提供者、药剂师、护士和老年病学家在内的多学科团队的领导下，8个退伍军人事务部急诊科正在进行中。在6个月时，实施APPED的研究中心一致表明潜在不适当药物的使用相对减少了近50% 9，10。 我们提出了一项实施研究，以评估VA医疗保健系统之外的UMPED。在资助期间，我们将开发一个工具包，以促进广泛传播和改善对通过艾德接受护理的老年人的护理，因为艾德迫切需要现代，容易获得的资源，以增加供应商的知识和传播安全药物处方的最佳做法，从ED出院的老年人。我们预计，调整，然后实施的老年人健康教育将导致实施后6个月，从艾德出院的老年人的潜在不适当药物处方相对减少50%。具体目标1：在三个非VA研究中心（Grady、杜克和Mt.西奈半岛），以证明VA系统外的可行性。具体目标2：使用REAIM框架在这3个站点中验证已验证的PED。具体目标3：开发一个工具箱，用于向非VA站点广泛传播。

 DESCRIPTION (provided by applicant): EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) Older adults are a vulnerable population at high risk for medication adverse drug events (ADEs) especially when they are discharged from the Emergency Department (ED). Recent studies have found that more than half of older adults discharged from the ED leave with a new prescription medication. Prescribing new medications for elderly patients outside the setting of geriatric primary care increases chances for suboptimal prescribing as well as ADEs, both major reasons for repeat ED visits, hospitalization or death 1,2 2-8. A system-wide approach to increase patient safety for older adults at the time of ED discharge is the focus of this proposal. EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) is an innovative quality improvement initiative designed to reduce potentially inappropriate medication prescribing to adults aged 65 years and older in the setting of the ED. EQUIPPED comprises three interventions that all address the Patient Safety Research Framework promoted by AHRQ: a) provider education via didactic education and journal club; b) electronic clinical decision support via specialized geriatric pharmacy order sets and links to online educational content at the point of prescribing; and c) academic detailing including audit and feedback and peer benchmarking. EQUIPPED is informed by the Beers Criteria, which are widely used by government agencies and supported by research in various settings1,6-7 as a marker of prescribing quality. EQUIPPED is currently underway in 8 Veterans Affairs EDs under the leadership of Drs. Vaughan and Stevens and a multidisciplinary team including geriatricians, emergency medicine providers, pharmacists, nurses, and gerontologists9. EQUIPPED implementation sites consistently demonstrate a relative reduction in the use of potentially inappropriate medications by nearly 50% at 6 months9,10. We propose an implementation study to evaluate EQUIPPED outside of the VA healthcare system. During the funding period we will develop a toolkit to facilitate broad dissemination and improved care for older adults receiving care through the ED as there is a pressing need in the ED for modern, easy to access resources to increase provider knowledge and disseminate best practices for safe medication prescribing to older adults who are discharged from the ED. We anticipate that the adaptation and then implementation of EQUIPPED will lead to a 50% relative reduction in potentially inappropriate medication prescriptions for older adults discharged from the ED at 6 months post-implementation. Specific Aim 1: IMPLEMENT EQUIPPED at three non-VA sites (Grady, Duke, and Mt. Sinai) to demonstrate feasibility outside the VA system. Specific Aim 2: EVALUATE EQUIPPED in these 3 sites using the REAIM framework. Specific Aim 3: Develop a toolbox for widespread DISSEMINATION to non-VA sites.