Trial Outcomes & Findings for Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED (NCT NCT04004936)
NCT ID: NCT04004936
Last Updated: 2026-02-25
Results Overview
Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED.
Recruitment status
COMPLETED
Study phase
NA
Target enrollment
74 participants
Primary outcome timeframe
12-Months Post Implementation of EQUIPPED
Results posted on
2026-02-25
Participant Flow
Participants were EQUIPPED implementation team members or providers at EQUIPPED implementation sites.
Unit of analysis: Sites
Participant milestones
| Measure |
Active Feedback
EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
|
Passive Feedback
EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
|
|---|---|---|
|
Overall Study
STARTED
|
36 4
|
38 4
|
|
Overall Study
COMPLETED
|
36 4
|
38 4
|
|
Overall Study
NOT COMPLETED
|
0 0
|
0 0
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
Age was self-reported and not reported by all participants
Baseline characteristics by cohort
| Measure |
Active Feedback
n=4 Sites
EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
|
Passive Feedback
n=4 Sites
EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
|
Total
n=8 Sites
Total of all reporting groups
|
|---|---|---|---|
|
Age, Categorical
<=18 years
|
0 Participants
n=28 Participants • Age was self-reported and not reported by all participants
|
0 Participants
n=30 Participants • Age was self-reported and not reported by all participants
|
0 Participants
n=58 Participants • Age was self-reported and not reported by all participants
|
|
Age, Categorical
Between 18 and 65 years
|
24 Participants
n=28 Participants • Age was self-reported and not reported by all participants
|
30 Participants
n=30 Participants • Age was self-reported and not reported by all participants
|
54 Participants
n=58 Participants • Age was self-reported and not reported by all participants
|
|
Age, Categorical
>=65 years
|
4 Participants
n=28 Participants • Age was self-reported and not reported by all participants
|
0 Participants
n=30 Participants • Age was self-reported and not reported by all participants
|
4 Participants
n=58 Participants • Age was self-reported and not reported by all participants
|
|
Sex: Female, Male
Female
|
12 Participants
n=27 Participants • Self-reported gender, not required to report
|
22 Participants
n=32 Participants • Self-reported gender, not required to report
|
34 Participants
n=59 Participants • Self-reported gender, not required to report
|
|
Sex: Female, Male
Male
|
15 Participants
n=27 Participants • Self-reported gender, not required to report
|
10 Participants
n=32 Participants • Self-reported gender, not required to report
|
25 Participants
n=59 Participants • Self-reported gender, not required to report
|
|
Ethnicity (NIH/OMB)
Hispanic or Latino
|
1 Participants
n=36 Participants
|
0 Participants
n=38 Participants
|
1 Participants
n=74 Participants
|
|
Ethnicity (NIH/OMB)
Not Hispanic or Latino
|
21 Participants
n=36 Participants
|
25 Participants
n=38 Participants
|
46 Participants
n=74 Participants
|
|
Ethnicity (NIH/OMB)
Unknown or Not Reported
|
14 Participants
n=36 Participants
|
13 Participants
n=38 Participants
|
27 Participants
n=74 Participants
|
|
Race (NIH/OMB)
American Indian or Alaska Native
|
0 Participants
n=36 Participants
|
0 Participants
n=38 Participants
|
0 Participants
n=74 Participants
|
|
Race (NIH/OMB)
Asian
|
2 Participants
n=36 Participants
|
2 Participants
n=38 Participants
|
4 Participants
n=74 Participants
|
|
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
|
0 Participants
n=36 Participants
|
0 Participants
n=38 Participants
|
0 Participants
n=74 Participants
|
|
Race (NIH/OMB)
Black or African American
|
1 Participants
n=36 Participants
|
1 Participants
n=38 Participants
|
2 Participants
n=74 Participants
|
|
Race (NIH/OMB)
White
|
18 Participants
n=36 Participants
|
21 Participants
n=38 Participants
|
39 Participants
n=74 Participants
|
|
Race (NIH/OMB)
More than one race
|
0 Participants
n=36 Participants
|
0 Participants
n=38 Participants
|
0 Participants
n=74 Participants
|
|
Race (NIH/OMB)
Unknown or Not Reported
|
15 Participants
n=36 Participants
|
14 Participants
n=38 Participants
|
29 Participants
n=74 Participants
|
|
Region of Enrollment
United States
|
36 Participants
n=36 Participants
|
38 Participants
n=38 Participants
|
74 Participants
n=74 Participants
|
|
Total Number of Discharge Prescriptions for Older Adults
Number of Discharge Prescriptions at Baseline
|
17,744 Prescriptions
n=4 Sites
|
26,936 Prescriptions
n=4 Sites
|
44680 Prescriptions
n=8 Sites
|
|
Total Number of Discharge Prescriptions for Older Adults
Number of Potentially Inappropriate Medications Prescribed at Baseline
|
1,421 Prescriptions
n=4 Sites
|
2,166 Prescriptions
n=4 Sites
|
3,590 Prescriptions
n=8 Sites
|
PRIMARY outcome
Timeframe: 12-Months Post Implementation of EQUIPPEDPopulation: Discharge prescriptions for Veterans 65 and older at EQUIPPED implementation sites within each group
Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED.
Outcome measures
| Measure |
Active Feedback
n=23648 Prescriptions
EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
|
Passive Feedback
n=36795 Prescriptions
EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
|
|---|---|---|
|
Percentage of PIMs Prescribed
|
1,672 Prescriptions
|
2,979 Prescriptions
|
SECONDARY outcome
Timeframe: 12-Months After the Delivery of the First EQUIPPED ReportPopulation: This outcome measure was assessed at the site level
Prescribers at participating EDs completed a survey at baseline, 6, and 12 months to assess perceived control related to prescribing as a factor that could be impacted by the EQUIPPED intervention. The outcome relates to the average reported perception of 'control' across site respondents by implementation group assignment. The 'perceived control' domain is assessed with a 1-5 Likert scale where 1=strongly disagree and 5=strongly agree with the statement, "I am in control of reducing the potentially inappropriate medications that I prescribe for older Veterans at the time of emergency department."
Outcome measures
| Measure |
Active Feedback
n=4 Sites
EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
|
Passive Feedback
n=4 Sites
EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
|
|---|---|---|
|
Social Cognitive Theory Survey - Perceived Control Domain
|
4.1 units on a scale
Standard Deviation 0.8
|
3.3 units on a scale
Standard Deviation 2.1
|
SECONDARY outcome
Timeframe: 12-Months Post Implementation of EQUIPPEDPopulation: This outcomes measure was assessed at the site level. Total cost to the organization based on allocation group (4 sites per group)
Micro-costing of the intervention will be done to learn details of specific factors that may impact the cost of the intervention to the Veterans Health Administration (organization)
Outcome measures
| Measure |
Active Feedback
n=4 Sites
EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
|
Passive Feedback
n=4 Sites
EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.
|
|---|---|---|
|
Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention
|
52,474 Dollars
|
28,122 Dollars
|
Adverse Events
Active Feedback
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Passive Feedback
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Dr. Elizabeth Camille Vaughan/ Atlanta Site Section Chief Birmingham/Atlanta GRECC
Atlanta VAHCS
Phone: 404 315 4100
Email: [email protected]
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place