Michael Parchman, MD, MPH

Kaiser Permanente Washington Health Research Institute

Can Value Champions Reduce Inappropriate Prescribing for People with Dementia?

Health Care Systems

U.S. Medical Management
Ochsner Health

Dr. Parchman is a primary care physician and a senior investigator at the MacColl Center for Healthcare Innovation within the Kaiser Permanente Washington Health Research Institute. He has over thirty years of primary care practice experience and work a medical educator. Dr. Parchman’s research has examined the effectiveness strategies to improve cardiovascular risk factors, methods to advance research in primary care settings, and theoretical underpinnings of the delivery of primary care. His current work focuses on addressing the overuse of low-value care services across health care settings. He recently served as director of a Robert Wood Johnson Foundation fellowship program to train clinical value champions who engage providers, staff, and patients in the reduction of low-value care services. This work demonstrated the effectiveness of these value champions and resulted in materials and resources for training future value champions.

RATIONALE: Overuse of potentially inappropriate medications among people living with dementia remains a persistent problem. Clinical value champions are front-line clinicians who can advocate for and influence practice-driven change at multiple levels within a health care organization.

OBJECTIVE: To train value champions across two large accountable care organizations to address over-prescribing of potentially inappropriate medications for people living with dementia. This pragmatic randomized clinical trial will examine the impact of this embedded intervention on prescribing outcomes and health care utilization, and assess its appropriateness, feasibility, fidelity, penetration, and equity.

SETTING: Two large accountable care organizations (ACOs) across 14 states.

POPULATION: Medicare patients with a diagnosis of dementia who are seen in primary care clinic settings.

INTERVENTION: Clinicians from randomly selected primary care settings in each ACO will participate in a six-month value champions training program and then engage fellow clinicians, staff and patients in efforts to de-implement potentially inappropriate medications for people living with dementia.

OUTCOMES: The primary outcome is a patient-level measure of exposure to one of three classes of potentially inappropriate medications ascertained from Medicare pharmacy claims data. Secondary outcomes include emergency department visits or a hospitalization for a fall, and five intermediate implementation outcomes: appropriateness, feasibility, fidelity, penetration, and equity.

IMPACT: This study will allow health care systems to gain real-world experience integrating this pragmatic intervention in a manner that provides clear information on its effectiveness and will enable them to train others to be value champions to address other overused services across additional clinical sites.