Scaling the EQUIPPED medication safety program : Traditional and hub-and-spoke implementation models
© 2024 The American Geriatrics Society..
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
|---|---|
| Enthalten in: |
Journal of the American Geriatrics Society - (2024) vom: 23. Jan. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Vandenberg, Ann E [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Academic detailing |
|---|
| Anmerkungen: |
Date Revised 23.01.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1111/jgs.18746 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM367495597 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM367495597 | ||
| 003 | DE-627 | ||
| 005 | 20240123232227.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240123s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/jgs.18746 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1268.xml |
| 035 | |a (DE-627)NLM367495597 | ||
| 035 | |a (NLM)38259070 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Vandenberg, Ann E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Scaling the EQUIPPED medication safety program |b Traditional and hub-and-spoke implementation models |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 23.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2024 The American Geriatrics Society. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a academic detailing | |
| 650 | 4 | |a emergency medicine | |
| 650 | 4 | |a health services research | |
| 650 | 4 | |a patient safety | |
| 650 | 4 | |a potentially inappropriate medication list | |
| 700 | 1 | |a Hwang, Ula |e verfasserin |4 aut | |
| 700 | 1 | |a Das, Shamie |e verfasserin |4 aut | |
| 700 | 1 | |a Genes, Nicholas |e verfasserin |4 aut | |
| 700 | 1 | |a Nyamu, Sylviah |e verfasserin |4 aut | |
| 700 | 1 | |a Richardson, Lynne |e verfasserin |4 aut | |
| 700 | 1 | |a Ezenkwele, Ugo |e verfasserin |4 aut | |
| 700 | 1 | |a Legome, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Richardson, Christopher |e verfasserin |4 aut | |
| 700 | 1 | |a Belachew, Adam |e verfasserin |4 aut | |
| 700 | 1 | |a Leong, Traci |e verfasserin |4 aut | |
| 700 | 1 | |a Kegler, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Vaughan, Camille P |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the American Geriatrics Society |d 1953 |g (2024) vom: 23. Jan. |w (DE-627)NLM000041769 |x 1532-5415 |7 nnns |
| 773 | 1 | 8 | |g year:2024 |g day:23 |g month:01 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/jgs.18746 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |j 2024 |b 23 |c 01 | ||