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2023 HSR&D/QUERI National Conference Abstract

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4036 — Provider Characteristics Associated with Viewership of the EQUIPPED Dashboard: A Medication Safety Audit and Feedback Health IT Solution

Lead/Presenter: George Jackson ,  COIN - Durham
All Authors: Burningham Z (Salt Lake City Veterans Affairs Medical Center IDEAS COIN; Department of Internal Medicine, Division of Epidemiology, University of Utah), Jackson GL (Durham Veterans Affairs Medical Center, Center of Innovation to Accelerate Discovery and Practice Transformation; Department of Population Health Sciences & Division of General Internal Medicine, Duke University) Kelleher J (Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Decatur, GA) Morris I (Durham Veterans Affairs Medical Center, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC) Stevens M (Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs; Department of Medicine, Division of General Medicine and Geriatrics, Emory University) Cohen J (Department of Emergency Medicine, New Orleans Veterans Affairs Medical Center, New Orleans, LA) Maloney G (Department of Emergency Medicine, Cleveland Veterans Affairs Medical Center, Cleveland, OH) Sauer BC (Salt Lake City Veterans Affairs Medical Center IDEAS COIN; Department of Internal Medicine, Division of Epidemiology, University of Utah) Halwani AS (Salt Lake City Veterans Affairs Medical Center IDEAS COIN; Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah) Vaughan CP (Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Decatur, GA, USA; Department of Medicine, Division of General Medicine and Geriatrics, Emory University)

Objectives:
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, informed by the American Geriatrics Society Beers Criteria for potentially inappropriate medications (PIMs) that should be avoided in patients 65 years or older. Dashboard uptake and utilization has been mixed among sites participating in an implementation trial and it is unclear what factors are driving variation in viewership. Here we present ED provider characteristics found to be associated with viewership of the EQUIPPED dashboard, adding insight into strategies for addressing barriers to use.

Methods:
We performed a retrospective analysis of EQUIPPED dashboard viewership among four Veterans Affairs (VA) EDs participating in an implementation trial. ED providers had access to the dashboard for a 1-year period. We extracted quantitative data from user interaction logs to determine a unique user count and dashboard view count. Provider characteristics and baseline PIM prescribing rate were extracted from the VA’s Corporate Data Warehouse. Proportions, means, and 95% Confidence Intervals (CI) were calculated to determine unadjusted differences between dashboard users vs. non-users. Logistic regression was used to examine the association between dashboard use and provider characteristics.

Results:
A total of 82 providers were oriented to the EQUIPPED dashboard. Among oriented providers, 40 (48.7%) had evidence of at least 1 dashboard view, with a mean of 8.5 views during the 1-year feedback period. Adjusted analyses suggest providers with a higher baseline PIM prescribing rate were more likely to use the dashboard (OR 1.22; 95% CI 1.01 – 1.47). Furthermore, providers at one specific ED 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.

Implications:
We hypothesized that dashboard viewership would be highest among younger providers as the literature has identified clear generational differences in use of technology among clinicians. However, baseline PIM prescribing rates appear to be more strongly associated with dashboard utilization than demographic factors, with those with higher PIM prescribing rates utilizing the dashboard more frequently. The EQUIPPED program communicates to sites that a 30-day PIM rate of less than 5% is considered the threshold for “optimal prescribing.” Adjusting how this is communicated during dashboard orientations and through the user interface should be considered so that providers classified as optimal prescribers remain motivated to use the dashboard to further improve their prescribing performance beyond the 5% threshold.

Impacts:
Understanding utilization of audit and feedback health IT solutions and the characterization of users provides insight into meaningful strategies for improving uptake and optimization of feedback that subsequently leads to provider behavioral changes and improved health outcomes.