Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system

Vandenberg, Ann E.; Kegler, Michelle C.; Hastings, Susan; Hwang, Ula; Wu, Daniel; Stevens, Melissa B.; Clevenger, Carolyn; Eucker, Stephanie A.; Genes, N.; Huang, Wennie; Ikpe‐Ekpo, Edidiong; Nassisi, Denise; Previll, Laura A.; Rodríguez, Sandra; Sanon, Martine; Schlientz, David; Vigliotti, Debbie; Vaughan, Camille P.

doi:10.1093/intqhc/mzaa077

Cited by 5 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Site characteristics of the three implementation sites are described in figure 1, and additional details have been published previously. 8 Two of the sites were level 1 trauma centres and the third a level 3 trauma centre. Annual ED encounters ranged from approximately 80 000-140 000 with 15%-20% of the patients seen classified as 65 years of age and older across the sites.…”

Section: Resultsmentioning

confidence: 99%

“…Details of this implementation strategy as a learning health system approach have been published previously. 8 Throughout the 3-year project, site champions and evaluation team leads met twice a month to discuss progress at the implementing site and lessons learnt. During a given implementation year, the local EQUIPPED team met on a weekly basis to facilitate order set implementation, adaptation of provider feedback forms, and prepare for the local site launch.…”

Section: Designmentioning

confidence: 99%

See 1 more Smart Citation

Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

et al. 2021

Self Cite

View full text Add to dashboard Cite

Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or less. We describe prescribing outcomes at three academic health systems adapting and sequentially implementing the EQUIPPED medication safety programme.EQUIPPED was adapted from a model developed in the Veterans Health Administration (VA) and sequentially implemented in one academic health system per year over a 3-year period. The monthly proportion of PIMs, as defined by the 2015 American Geriatrics Beers Criteria, of all medications prescribed to adults aged 65 years and older at discharge was assessed for 6 months preimplementation until 12 months postimplementation using a generalised linear time series model with a Poisson distribution.The EQUIPPED programme was translated from the VA health system and its electronic medical record into three health systems each using a version of the Epic electronic medical record. Adaptation occurred through local modification of order sets and in the generation and delivery of provider prescribing reports by local champions. Baseline monthly PIM proportions 6 months prior to implementation at the three sites were 5.6% (95% CI 5.0% to 6.3%), 5.8% (95% CI 5.0% to 6.6%) and 7.3% (95% CI 6.4% to 9.2%), respectively. Evaluation of monthly prescribing including the twelve months post-EQUIPPED implementation demonstrated significant reduction in PIMs at one of the three sites. In exploratory analyses, the proportion of benzodiazepine prescriptions decreased across all sites from approximately 17% of PIMs at baseline to 9.5%–12% postimplementation, although not all reached statistical significance.EQUIPPED is feasible to implement outside the VA system. While the impact of the EQUIPPED model may vary across different health systems, results from this initial translation suggest significant reduction in specific high-risk drug classes may be an appropriate target for improvement at sites with relatively low baseline PIM prescribing rates.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recently, an article was published about a scale-up programme that aimed to reduce the prescription of potentially inappropriate medication at the emergency department 39. No new determinants were described; the authors confirmed with focus groups the importance of the creation of a learning community, the need for buy-in from stakeholders, the use of data, continuous monitoring and providing feedback, and the adaptability of the strategy components, such as site-specific education.…”

Section: Discussionmentioning

confidence: 99%

Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study

et al. 2022

View full text Add to dashboard Cite

ObjectiveWe aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework.Design and methodsThis study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies.ResultsThe literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients’ perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters.ConclusionsThe SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.

show abstract

“…Implementation team members varied across sites but typically included geriatricians, ED physicians, pharmacists, EHR/IT experts, and a project coordinator. Implementation was sequential, one occurring each year, across the four sites (see Table 1), building program knowledge over time that could be applied at each subsequent site (48). PIMS-related outcomes for the first three EDs are reported elsewhere (16).…”

Section: Methodsmentioning

confidence: 99%

Use of the consolidated framework for implementation research in a mixed methods evaluation of the EQUIPPED medication safety program in four academic health system emergency departments

Kegler

Rana²,

Vandenberg³

et al. 2022

Front.Health Serv.

Self Cite

View full text Add to dashboard Cite

BackgroundEnhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) is an effective quality improvement program initially designed in the Veterans Administration (VA) health care system to reduce potentially inappropriate medication prescribing for adults aged 65 years and older. This study examined factors that influence implementation of EQUIPPED in EDs from four distinct, non-VA academic health systems using a convergent mixed methods design that operationalized the Consolidated Framework for Implementation Research (CFIR). Fidelity of delivery served as the primary implementation outcome.Materials and methodsFour EDs implemented EQUIPPED sequentially from 2017 to 2021. Using program records, we scored each ED on a 12-point fidelity index calculated by adding the scores (1–3) for each of four components of the EQUIPPED program: provider receipt of didactic education, one-on-one academic detailing, monthly provider feedback reports, and use of order sets. We comparatively analyzed qualitative data from focus groups with each of the four implementation teams (n = 22) and data from CFIR-based surveys of ED providers (108/234, response rate of 46.2%) to identify CFIR constructs that distinguished EDs with higher vs. lower levels of implementation.ResultsOverall, three sites demonstrated higher levels of implementation (scoring 8–9 of 12) and one ED exhibited a lower level (scoring 5 of 12). Two constructs distinguished between levels of implementation as measured through both quantitative and qualitative approaches: patient needs and resources, and organizational culture. Implementation climate distinguished level of implementation in the qualitative analysis only. Networks and communication, and leadership engagement distinguished level of implementation in the quantitative analysis only.DiscussionUsing CFIR, we demonstrate how a range of factors influence a critical implementation outcome and build an evidence-based approach on how to prime an organizational setting, such as an academic health system ED, for successful implementation.ConclusionThis study provides insights into implementation of evidence-informed programs targeting medication safety in ED settings and serves as a potential model for how to integrate theory-based qualitative and quantitative methods in implementation studies.

show abstract

Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system

Cited by 5 publications

References 18 publications

Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study

Use of the consolidated framework for implementation research in a mixed methods evaluation of the EQUIPPED medication safety program in four academic health system emergency departments

Contact Info

Product

Resources

About