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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
200
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.
Yale New Haven Hospital Emergency Departments
New Haven, Connecticut, United States
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.
Time frame: At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up
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.
Time frame: At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up
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.
Time frame: 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.
Time frame: 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.
Time frame: Measured at 30 days post-discharge for all eligible ED visits during the 12-month intervention period and 6-month follow-up
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