Abstract: The Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUIPPED) program is a quality improvement initiative that combines education, clinical decision support (i.e., tailored geriatric pharmacy order sets), and in-person academic detailing coupled with audit and feedback in an effort to improve appropriate prescribing to older Veterans discharged from the emergency department. Although the EQUIPPED program has been shown to be effective at reducing the prescribing of potentially inappropriate medications, uncertainty on the optimal strategy of implementation remains. Studies have found no difference in effectiveness when comparing resource intensive academic detailing coupled with audit and feedback versus audit and feedback provided solely from prepared reports and without in-person prescribing outreach. With the recent advent of Health Information Technology, audit and feedback could be provided as near to real time as possible by means of a clinical dashboard reporting system. This knowledge has led to the development of the EQUIPPED Potentially Inappropriate Medication Dashboard (EPIMD); a passive, yet continuous standalone audit and feedback mechanism developed to potentially replace in-person academic detailing of the traditional EQUIPPED program. Here we describe the development process of the EPIMD and key audit and feedback components we found were necessary to include in the dashboard reporting system.

Describe the new knowledge and additional skills the participant will gain after attending your presentation.: The audience will come to learn about the development process of the EQUIPPED Potentially Inappropriate Medication Dashboard (EPIMD). We will cover in-depth the tools, analytic platforms, and software utilized to provide a near real-time dashboard to a base of national clincial end users. We will discuss the security model utilized in order to keep protected health information safe and describe the underlying data workflows used to support the dashboard, including the methods employed to optimize the extraction and transformation of the data prior to loading for dashboard visualization (i.e., parallal processing, modularized/reproducible procedures). We will also present the usability evaluation performed in ensuring the user experience was suitable for the target clinical end users. Overall, the development process of the EPIMD will be presented with generalizability in mind, so those not working within the Veterans Affairs (VA) environment will still be able to leverage our work and experiences.

In addition to covering the EPIMD development process, we will also present in great detail the core dashboard components identified as necessary to ensure the clinical end users experience provided similar benefits as one would obtain when participating in face-to-face academic detailing (i.e., decision support elements, alternative therapies, integrated automated email solution). We will describe in detail the audit and feedback (A&F) data elements, visualizations, and functions (i.e., KPIs, peer to peer benchmarking, longitudinal trends, drill downs, etc.) that were included and also cover in-depth how the EQUIPPED team came to discover these A&F characteristics and agreed upon their inclusion.


Zachary Burningham (Presenter)
Salt Lake City VA Medical Center

George Jackson, Duke University
Jessica Kelleher, Department of Veterans Affairs
Melissa Stevens, Department of Veterans Affairs
Isis Morris, Durham VA Medical Center
Joy Cohen, New Orleans VA Medical Center
Gerald Maloney, Cleveland VA Medical Center
Camille Vaughan, Department of Veterans Affairs