Scaling the EQUIPPED medication safety program: Traditional and hub‐and‐spoke implementation models.
Background: The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence‐informed quality improvement initiative to reduce potentially inappropriate medications (PIMs) prescribed by Emergency Department (...
| Publicado en: | Journal of the American Geriatrics Society Vol. 72; no. 7; pp. 2184 - 2195 |
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| Autores principales: | , , , , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Wiley-Blackwell
Jul2024
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=178297101&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 178297101 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Jul2024 vid: 72 iid: 7 pid: 480 pub: Wiley-Blackwell artinfo: ui: 178297101 10.1111/jgs.18746 ppf: 2184 ppct: 11 formats: tig: atl: Scaling the EQUIPPED medication safety program: Traditional and hub‐and‐spoke implementation models. aug: au: Vandenberg, Ann E. Hwang, Ula Das, Shamie Genes, Nicholas Nyamu, Sylviah Richardson, Lynne Ezenkwele, Ugo Legome, Eric Richardson, Christopher Belachew, Adam Leong, Traci Kegler, Michelle Vaughan, Camille P. affil: Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta Georgia,, USA Department of Emergency Medicine, NYU Grossman School of Medicine, New York New York,, USA James J. Peters VA Medical Center GRECC, Bronx New York,, USA Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York New York,, USA Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta Georgia,, USA Department of Behavioural, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta Georgia,, USA Birmingham/Atlanta VA GRECC, Atlanta Georgia,, USA su: Medical care research Patient safety Human services programs Evaluation of human services programs Interviewing COVID-19 pandemic Inappropriate prescribing (Medicine) Research funding Pilot projects Discharge planning Hospital emergency services Descriptive statistics Pre-tests & post-tests Longitudinal method Physician practice patterns Electronic health records Research Quality assurance Drug prescribing Evidence-based medicine Comparative studies sug: subj: Medical care research Patient safety Human services programs Evaluation of human services programs Interviewing COVID-19 pandemic Inappropriate prescribing (Medicine) Research funding Pilot projects Discharge planning Hospital emergency services Descriptive statistics Pre-tests & post-tests Longitudinal method Physician practice patterns Electronic health records Research Quality assurance Drug prescribing Evidence-based medicine Comparative studies keyword: academic detailing emergency medicine health services research patient safety potentially inappropriate medication list academic detailing emergency medicine health services research patient safety potentially inappropriate medication list ab: Background: The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence‐informed quality improvement initiative to reduce potentially inappropriate medications (PIMs) prescribed by Emergency Department (ED) providers to adults aged 65 and older at discharge. We aimed to scale‐up this successful program using (1) a traditional implementation model at an ED with a novel electronic medical record and (2) a new hub‐and‐spoke implementation model at three new EDs within a health system that had previously implemented EQUIPPED (hub). We hypothesized that implementation speed would increase under the hub‐and‐spoke model without cost to PIM reduction or site engagement. Methods: We evaluated the effect of the EQUIPPED program on PIMs for each ED, comparing their 12‐month baseline to 12‐month post‐implementation period prescribing data, number of months to implement EQUIPPED, and facilitators and barriers to implementation. Results: The proportion of PIMs at all four sites declined significantly from pre‐ to post‐EQUIPPED: at traditional site 1 from 8.9% (8.1–9.6) to 3.6% (3.6–9.6) (p < 0.001); at spread site 1 from 12.2% (11.2–13.2) to 7.1% (6.1–8.1) (p < 0.001); at spread site 2 from 11.3% (10.1–12.6) to 7.9% (6.4–8.8) (p = 0.045); and at spread site 3 from 16.2% (14.9–17.4) to 11.7% (10.3–13.0) (p < 0.001). Time to implement was equivalent at all sites across both models. Interview data, reflecting a wide scope of responsibilities for the champion at the traditional site and a narrow scope at the spoke sites, indicated disproportionate barriers to engagement at the spoke sites. Conclusions: EQUIPPED was successfully implemented under both implementation models at four new sites during the COVID‐19 pandemic, indicating the feasibility of adapting EQUIPPED to complex, real‐world conditions. The hub‐and‐spoke model offers an effective way to scale‐up EQUIPPED though a speed or quality advantage could not be shown. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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