Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics

• Authors: Zach Burningham, Salt Lake City Veterans Affairs Medical Center; George L. Jackson, Durham Veterans Affairs Health Care System; Jessica L. Kelleher, Department of Veterans Affairs Decatur; Isis Morris, Durham Veterans Affairs Health Care System; Melissa B Stevens, Emory University; Joy Cohen, New Orleans Veterans Affairs Medical Center; Gerald Maloney, Cleveland Veterans Affairs Medical Center; Brian C. Sauer, Salt Lake City Veterans Affairs Medical Center; Ahmad S. Halwani, Salt Lake City Veterans Affairs Medical Center; Wei Chen, Salt Lake City Veterans Affairs Medical Center; Camille Vaughan, Emory University
• Journal Title: Applied Clinical Informatics
• Volume: Volume 14, Number 4
• Publisher: Thieme | 2023-08-30, Pages 684-692
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1055/s-0043-1771393
• Subjects: Health Sciences, Health Care Management
• Keywords: medication management; emergency medicine; dashboard; incentives/barriers; diffusion of innovation; electronic health record (EHR); enterprise data warehouses (EDWs); Veterans Affairs

Abstract

Background  The Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUIPPED) program developed an audit and feedback health information technology (IT) solution with the intent to replace the in-person academic detailing service provided by the program. The EQUIPPED dashboard provides emergency department (ED) providers with a personalized view of their prescribing performance. Objectives  Here, we analyze the association between ED provider characteristics and viewership of the EQUIPPED dashboard, adding insight into strategies for addressing barriers to initial use. Methods  We performed a retrospective analysis of EQUIPPED dashboard viewership among four Veterans Affairs (VA) EDs. We extracted quantitative data from user interaction logs to determine evidence of dashboard use. Provider characteristics and baseline potentially inappropriate medication (PIM) prescribing rate were extracted from the VA's Corporate Data Warehouse. Logistic regression was used to examine the association between dashboard use and provider characteristics. Results  A total of 82 providers were invited to receive audit and feedback via the EQUIPPED dashboard. Among invited providers, 40 (48.7%) had evidence of at least 1 dashboard view during the 1-year feedback period. Adjusted analyses suggest that providers with a higher baseline PIM prescribing rate were more likely to use the dashboard (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.01–1.47). Furthermore, providers at ED site D were more likely to use the dashboard in comparison to the other sites (OR: 9.99; 95% CI: 1.72–58.04) and reportedly had the highest site-level baseline PIM rate. Conclusion  Providers with lower PIM prescribing rates (i.e., <5%) receive communication from an integrated dashboard reminder system that they are “optimal prescribers” which may have discouraged initial attempts to view the dashboard. Site D had the highest baseline PIM rate, but further qualitative investigation is warranted to better understand why site D had the greatest users of the dashboard.