Scaling E.Q.U.I.P.P.E.D. Clinical Decision Support (Georgia)

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The prescription of potentially inappropriate medications (PIMs) to older adults upon discharge from the emergency department (ED) is a common yet preventable event. Episodes of suboptimal prescribing in the ED have increased as more older adults are discharged to home rather than admitted to an inpatient unit. These increases have been attributed to lack of emergency medicine geriatric training, insufficient knowledge of age-related changes in how the body responds to and metabolizes medications, and time constraints in treating older adults with multiple morbidities in this setting. Consequences of suboptimal prescribing include an increased risk of repeat ED visits, hospitalizations, and death.

Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) is a well-established quality improvement initiative designed to decrease the number of PIMs prescribed to adults aged 65 and older upon discharge from the ED. EQUIPPED Clinical Decision Support (CDS), includes education sessions on clinical guidelines for geriatric prescribing, point-of-care prescribing order sets implemented in the existing electronic health record (EHR), and behavioral reinforcement in the form of monthly audits and feedback with peer benchmarking. Successfully implemented into the Veteran Health Administration’s EHR at 11 sites and into a commercial EHR at 3 academic hospitals, EQUIPPED CDS resulted in a significant and sustained reduction in average monthly PIMs prescribed to older adults at ED discharge. Most recently, the initiative increased the percentage of prescribers who prescribed zero PIMs from 27 to 71. These results indicate that EQUIPPED CDS is ready to be scaled and spread beyond these two EHRs.

The specific aims of the research are as follows:

  • Scale EQUIPPED CDS in two ways: 1) to three additional ED satellites of an existing EQUIPPED site that use the Epic EHR, and 2) into a new EHR, Cerner/PowerChart, at a new academic site ED. 
  • Evaluate scale-up using Reach-Effectiveness-Adoption-Implementation-Maintenance framework. 

By scaling to EHRs that are well established and widely used, EQUIPPED has the potential to reach approximately 45 percent of the civilian EDs in the United States, in addition to 100 percent of the VA EDs. The implementation will also extend EQUIPPED to a community hospital setting. In doing so, it will increase the diversity of providers and patients potentially impacted by EQUIPPED.

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