Dual Use of Medications (DUAL) Partnered Evaluation Initiative

退伍军人管理局药物安全中心(VAMedSAFE)负责提高 退伍军人。VAMedSAFE的干预措施针对最严重、最普遍和最优先的健康状况 在退伍军人中，然而他们有一个关键的限制-他们不能解释 退伍军人以外的退伍军人。超过80%的退伍军人管理局登记人员可以通过其他形式的健康获得药物 保险，包括50%的医疗保险。有强有力的证据表明，接受来自多个 卫生系统构成严重的健康风险。无法将非退伍军人管理局的处方与退伍军人管理局的药物整合 监督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，退伍军人管理局与医疗保险和医疗补助中心签署了一项开创性的协议 将退伍军人在Medicare中填写的处方的CMS数据整合到VAMedSAFE的服务(CMS) 持续的安全监控活动--这是退伍军人管理局以前从未能够做到的。在日历结束前 2020年，VAMedSAFE将收到并清理CMS关于所有人分发的联邦医疗保险处方的数据 招募退伍军人，并将这些数据纳入他们正在进行的药物监测活动中。 我们提出的药物双重用途(Dual)合作评估倡议的目标是帮助 VAMedSAFE在开发和评估使用这些组合的新质量增强工具的推出方面 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，我们将努力 使用VAMedSAFE对整合CMS时要优先考虑的药物类型进行形式化评估 将处方数据输入他们的质量增强工具。目标1a将量化CMS的整合 处方数据可能会影响暴露测量(例如，确定为事故的患者数量 药物使用者)和结果(例如，发生与药物有关的不良事件的患者的数量 正在进行的VAMedSAFE监视计划。目标1b将为新的退伍军人管理局药物安全确定高影响目标 使用CMS/VA数据的举措，使用定量和定性分析。我们将查询CMS/VA 用于确定经常重复或重叠的广泛药物类别(例如，低血糖、阿片类药物)的数据 在CMS和VA之间。然后，我们将召集两个有关键利益相关者的跨学科焦点小组，以 使用CMS/VA数据确定未来干预措施的其他潜在高影响药物靶点。在目标2中， 我们将评估终端用户首次将CMS数据集成到VAMedSAFE药物安全性中的体验 专注于直接作用口服抗凝剂安全性的仪表盘。以实际、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、学术细节人员、临床医生)，以确定实施障碍和促进者并学习 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 会导致意想不到的后果。最后，在AIM 3中，我们将与VAMedSAFE合作设计和部署 使用整合的CMS和VA数据对第二个药物安全仪表板进行阶梯式楔形随机评估， 使用目标1和目标2的调查结果来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、采用)成果。 这些新数据为加强退伍军人用药安全监测提供了前所未有的机遇 通过医疗保险接受药物治疗的退伍军人。这项评估是应以下机构的要求进行的，并由 VAMedSAFE，这需要非研究伙伴关系，因为CMS/VA数据只能用于质量 进步。该项目与退伍军人管理局QUERI优先事项保持一致，将实施科学应用于现实世界 实践，使用新的数据源以提高质量，并帮助方案办公室建设数据能力和 评估新的质量增强工具。

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.