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. 2024 Jul;72(7):2184-2194.
doi: 10.1111/jgs.18746. Epub 2024 Jan 23.

Scaling the EQUIPPED medication safety program: Traditional and hub-and-spoke implementation models

Ann E Vandenberg  1 , Ula Hwang  2   3 , Shamie Das  1 , Nicholas Genes  2 , Sylviah Nyamu  4 , Lynne Richardson  4 , Ugo Ezenkwele  4 , Eric Legome  4 , Christopher Richardson  4 , Adam Belachew  4 , Traci Leong  5 , Michelle Kegler  6 , Camille P Vaughan  1   7
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Scaling the EQUIPPED medication safety program: Traditional and hub-and-spoke implementation models

Ann E Vandenberg et al. J Am Geriatr Soc. 2024 Jul.

Abstract

Background: The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence-informed quality improvement initiative to reduce potentially inappropriate medications (PIMs) prescribed by Emergency Department (ED) providers to adults aged 65 and older at discharge. We aimed to scale-up this successful program using (1) a traditional implementation model at an ED with a novel electronic medical record and (2) a new hub-and-spoke implementation model at three new EDs within a health system that had previously implemented EQUIPPED (hub). We hypothesized that implementation speed would increase under the hub-and-spoke model without cost to PIM reduction or site engagement.

Methods: We evaluated the effect of the EQUIPPED program on PIMs for each ED, comparing their 12-month baseline to 12-month post-implementation period prescribing data, number of months to implement EQUIPPED, and facilitators and barriers to implementation.

Results: The proportion of PIMs at all four sites declined significantly from pre- to post-EQUIPPED: at traditional site 1 from 8.9% (8.1-9.6) to 3.6% (3.6-9.6) (p < 0.001); at spread site 1 from 12.2% (11.2-13.2) to 7.1% (6.1-8.1) (p < 0.001); at spread site 2 from 11.3% (10.1-12.6) to 7.9% (6.4-8.8) (p = 0.045); and at spread site 3 from 16.2% (14.9-17.4) to 11.7% (10.3-13.0) (p < 0.001). Time to implement was equivalent at all sites across both models. Interview data, reflecting a wide scope of responsibilities for the champion at the traditional site and a narrow scope at the spoke sites, indicated disproportionate barriers to engagement at the spoke sites.

Conclusions: EQUIPPED was successfully implemented under both implementation models at four new sites during the COVID-19 pandemic, indicating the feasibility of adapting EQUIPPED to complex, real-world conditions. The hub-and-spoke model offers an effective way to scale-up EQUIPPED though a speed or quality advantage could not be shown.

Keywords: academic detailing; emergency medicine; health services research; patient safety; potentially inappropriate medication list.

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References

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