Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics

Zach Burningham; George L. Jackson; Jessica L. Kelleher; Isis Morris; Melissa B. Stevens; Joy Cohen; Gerald Maloney; Brian C. Sauer; Ahmad S. Halwani; Wei Chen; Camille P. Vaughan

doi:10.1055/s-0043-1771393

Applied Clinical Informatics, Table of Contents

CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(04): 684-692
DOI: 10.1055/s-0043-1771393

Research Article

Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics

Zach Burningham

¹Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States

²Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States

,

George L. Jackson

³Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States

⁴Medicine (Division of General Internal Medicine), and Family Medicine & Community Health, Departments of Population Health Sciences, Duke University, Durham, North Carolina, United States

,

Jessica L. Kelleher

⁵Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States

,

Isis Morris

³Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States

,

Melissa B. Stevens

⁵Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States

⁶Division of General Medicine and Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia, United States

,

Joy Cohen

⁷Department of Emergency Medicine, New Orleans Veterans Affairs Medical Center, New Orleans, Louisiana, United States

,

Gerald Maloney

⁸Department of Emergency Medicine, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States

,

Brian C. Sauer

¹Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States

,

Ahmad S. Halwani

¹Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States

⁹Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States

,

Wei Chen

¹Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States

,

Camille P. Vaughan

⁵Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States

› Author Affiliations

Abstract

Background The Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUIPPED) program developed an audit and feedback health information technology (IT) solution with the intent to replace the in-person academic detailing service provided by the program. The EQUIPPED dashboard provides emergency department (ED) providers with a personalized view of their prescribing performance.

Objectives Here, we analyze the association between ED provider characteristics and viewership of the EQUIPPED dashboard, adding insight into strategies for addressing barriers to initial use.

Methods We performed a retrospective analysis of EQUIPPED dashboard viewership among four Veterans Affairs (VA) EDs. We extracted quantitative data from user interaction logs to determine evidence of dashboard use. Provider characteristics and baseline potentially inappropriate medication (PIM) prescribing rate were extracted from the VA's Corporate Data Warehouse. Logistic regression was used to examine the association between dashboard use and provider characteristics.

Results A total of 82 providers were invited to receive audit and feedback via the EQUIPPED dashboard. Among invited providers, 40 (48.7%) had evidence of at least 1 dashboard view during the 1-year feedback period. Adjusted analyses suggest that providers with a higher baseline PIM prescribing rate were more likely to use the dashboard (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.01–1.47). Furthermore, providers at ED site D were more likely to use the dashboard in comparison to the other sites (OR: 9.99; 95% CI: 1.72–58.04) and reportedly had the highest site-level baseline PIM rate.

Conclusion Providers with lower PIM prescribing rates (i.e., <5%) receive communication from an integrated dashboard reminder system that they are “optimal prescribers” which may have discouraged initial attempts to view the dashboard. Site D had the highest baseline PIM rate, but further qualitative investigation is warranted to better understand why site D had the greatest users of the dashboard.

Keywords

medication management - emergency medicine - dashboard - incentives/barriers - diffusion of innovation

Full Text

References

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Supplementary Material

Supplementary Material