A cluster‐randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program

• Published in: Academic emergency medicine Vol. 30; no. 4; pp. 340 - 348
• Main Authors: Vaughan, Camille P., Burningham, Zach, Kelleher, Jessica L., McGwin, Gerald, Jasien, Christine L., Hastings, S. Nicole, Stevens, Melissa B., Morris, Isis, Jackson, George L., Driver, Jane, Mac, Chi, Scott, Lancer, Manaktala, Rohit, Calkins, Peter, Ostrom, Jaimie, Abbate, Lauren, Beyth, Rebecca, Cellarosi‐Yorba, Patrick, Violette, Jeffrey, Minix, Amy, Putnam, Tracy, Corcoran, Kevin, Carter, Michael
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-04-2023
• Subjects: academic detailing; Aged; aging; audit and feedback; Audits; clinical decision support; COVID-19; emergency department; Emergency medical care; Feedback; Humans; Inappropriate Prescribing; medication safety; Older people; Pandemics; Quality Improvement; Safety programs; United States; Veterans health care; United States; audit and feedback; medication safety; aging; emergency department; academic detailing; clinical decision support
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.14697

Objectives
The Enhancing the Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) medication safety program involves three core components including provider education, clinical decision support, and audit and feedback using the American Geriatrics Society Beers Criteria to determine potentially inappropriate medications (PIMs). This study evaluated implementation of audit and feedback through a centralized informatics‐based dashboard compared to academic detailing delivered one on one by an EQUIPPED champion.
Methods
In a cluster‐randomized study (October 2019–September 2021), eight VA emergency department (EDs) implemented either the academic detailing (n = 4) or the dashboard (n = 4) strategy for the audit and feedback component of EQUIPPED. The primary outcome was the monthly proportion of PIMs prescribed to Veterans 65 years or older at ED discharge. Poisson regression was used to evaluate the proportion of PIMs prescribed 6 months prior to EQUIPPED implementation compared to 12 months following implementation.
Results
Eight VA ED sites successfully implemented the EQUIPPED program. During the 6‐month baseline period, the academic detailing and dashboard sites had similar PIM prescribing rates of 8.01% for academic detailing versus 8.04% for dashboard (p = 0.90). Comparing 12 months of prescribing data after EQUIPPED implementation, the academic detailing group significantly improved PIM prescribing (7.07%) compared to the dashboard group (8.10%; odds ratio 1.14, 95% confidence interval 1.08–1.22, p ≤ 0.0001). Within the groups, two of the four academic detailing sites demonstrated statistically significant reductions in PIM prescribing. One of the four dashboard sites achieved nearly 50% relative reduction in PIM prescribing.
Conclusions
Eight VA EDs successfully implemented the core components of the EQUIPPED program amid the unprecedented challenges posed by the COVID‐19 pandemic. While the academic detailing approach to EQUIPPED audit and feedback was more effective at the group level to improve safe prescribing for older Veterans discharged from the ED, the trial suggests that dashboard‐based audit and feedback is a reasonable strategy in resource‐limited settings.