September 27, 2022
IMPACT Demonstration Projects Program Award recipient, Michael Parchman, MD, MPH, is co-author and co-investigator on a new 24-month embedded pragmatic cluster-randomized clinical aiming to:
- Assess the effectiveness of clinician champion intervention strategies on de-implementing potentially inappropriate medications (PIMs) in PLWD
- Determine if the intervention is associated with a reduction in emergency department (ED) visits and hospitalizations attributed to a fall
- Examine five implementation outcomes: appropriateness, feasibility, fidelity, penetration, and equity
Methods/design
The trial is being conducted in two accountable care organizations: United States Medical Management (USMM) and Oschner Health System. The unit of randomization will be the primary care clinic. A clinician champion will be recruited from each of the intervention clinics to participate in a 6-month training program and then work with clinicians and staff in their clinic for 12 months to reduce the use of PIMs in their PLWD population. For aims 1 and 2, Medicare claims data will be used to assess outcomes. The outcome for aim #1 will be medication possession rates per quarter, for the three therapeutic classes of PIMs among patients with dementia in intervention clinics versus control clinics. For aim #2, researchers will assess the incidence of falls using a previously validated algorithm. For both aims 1 and 2, researchers will construct hierarchical models with time period observations nested within patient using generalized estimating equations (GEE) with robust standard errors. The key variable of interest will be the treatment indicator assigned based on practice. For aim #3, the team will conduct qualitative thematic analysis of documentation by the clinician champions in their project workbooks to evaluate the five implementation outcomes.
Read the full article at this link.