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| ID | Type | Description | Link |
|---|---|---|---|
| P30AG024968 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Aging (NIA) | NIH |
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Cluster-randomized trial assessing the impact of interventions on guideline-concordant prescribing in Emergency Departments (ED). The study compares the effectiveness of feedback messages about potentially inappropriate medications (PIMs) delivered by peer clinician prescribers or anonymous systems, compared to standard of care. The goal is to reduce PIM prescribing for older adults discharged from emergency departments.
The goal of this trial is to compare the effectiveness of prescribing feedback delivered by a credible peer messenger and by an anonymous messaging system against standard of care in emergency departments. This intervention to Emergency Department (ED) clinician prescribers is a modification of previous studies that optimizes feedback about Potentially Inappropriate Medications (PIMs) using findings from behavioral science. Clinician prescribers who meet eligibility criteria and provide digital affirmative consent will be enrolled if they have encounters in a participating ED facility. The Joint Data Analytics Team (JDAT) will identify patients aged 65 years and older who were seen in the ED to evaluate prescribing outcomes. The focus of this registration is the randomized trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Credible Peer Messenger | Experimental | Providers receive automated prescribing feedback messages from a credible peer messenger, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices. |
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| Anonymous Messenger | Experimental | Providers receive automated prescribing feedback messages from an anonymous messenger system, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices. |
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| Control group | No Intervention | Providers continue with standard of care. No feedback messages are sent. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prescribing Feedback | Behavioral | Automated prescribing feedback messages are delivered to clinician prescribers in participating emergency departments. Messages are based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations and include aspirational norms and benchmark comparisons. Depending on study arm, feedback is sent either from a credible peer messenger or through an anonymous messenger system. |
| Measure | Description | Time Frame |
|---|---|---|
| Change PIM prescribing rate | Change in potentially inappropriate medication (PIM) prescribing rate based on the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx). Outcome is measured as the percentage of Emergency Department (ED) discharge prescriptions for PIMs among patients aged 65 years or older. | At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in prescribing by medication class | Changes in prescribing rates for high-risk medication classes identified in the GEMS-Rx based on percentage of ED discharge prescriptions for each targeted medication class among patients aged 65 years or older. | At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Daniella Meeker, PhD | Yale University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Yale New Haven Hospital Emergency Departments | New Haven | Connecticut | 06520 | United States |
De-identified data will be transferred to the National Archive for Computerized Data On Aging (NACDA)
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Made available upon publication.
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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The study population are Emergency Medicine prescribers practicing in the Yale New Haven Health System with at least 30 visits with patients over age 65.
Patients are not target subjects but that their data will be utilized from the medical record, pre- and post-intervention.
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| Adoption of alternative recommendations | Percentage of ED discharge encounters in which a recommended alternative medication was prescribed in place of a PIM based on percentage of eligible encounters. | Monthly during the 12-month intervention period and 6-month follow-up |
| Access to Epic workbench reports | Access to Epic workbench prescribing reports and message links (including Frequently Asked Questions, FAQs) based on number of accesses per clinician per month. | Monthly during the 12-month intervention period and 6-month follow-up |
| Mean overall readmission rate | All-cause readmission rates will be monitored to assess safety based on percentage of ED discharge encounters followed by any hospital readmission within 30 days. | Measured at 30 days post-discharge for all eligible ED visits during the 12-month intervention period and 6-month follow-up |