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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
1   Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
2   Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
George L. Jackson
3   Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
4   Medicine (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
5   Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States
,
Isis Morris
3   Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
,
Melissa B. Stevens
5   Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States
6   Division of General Medicine and Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia, United States
,
Joy Cohen
7   Department of Emergency Medicine, New Orleans Veterans Affairs Medical Center, New Orleans, Louisiana, United States
,
Gerald Maloney
8   Department of Emergency Medicine, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States
,
Brian C. Sauer
1   Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
,
Ahmad S. Halwani
1   Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
9   Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
Wei Chen
1   Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
,
Camille P. Vaughan
5   Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia, United States
› Author Affiliations Funding This work was supported in part by the Department of Veterans Affairs Health Services & Research Development Service (grant number: 1I01 HX 002527-01A1), Department of Veterans Affairs Office of Geriatrics and Extended Care, and by the resources and use of facilities at the United States Department of Veterans Affairs facilities at the Atlanta VA Medical Center, Durham Medical Center, and the Salt Lake City Health Care System.
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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

Protection of Human and Animal Subjects

This work was characterized as a nonresearch operational activity and not human subject research.


Supplementary Material



Publication History

Received: 21 February 2023

Accepted: 17 May 2023

Article published online:
30 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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