Reducing Inappropriate Outpatient Medication Prescribing in Older Adults across Electronic Health Record Systems

Abstract Background  The American Geriatrics Society recommends against the use of certain potentially inappropriate medications (PIMs) in older adults. Prescribing of these medications correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt University Medical Cen...

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Bibliographic Details
Published in:Applied clinical informatics 2020-10, Vol.11 (5), p.865-872
Main Authors: Friebe, Michael P., LeGrand, Joseph R., Shepherd, Bryan E., Breeden, Elizabeth A., Nelson, Scott D.
Format: Article
Language:English
Subjects:
Aged
Decision Support Systems, Clinical
Electronic Health Records
Humans
Inappropriate Prescribing
Outpatients
Potentially Inappropriate Medication List
Research Article
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Summary:Abstract Background  The American Geriatrics Society recommends against the use of certain potentially inappropriate medications (PIMs) in older adults. Prescribing of these medications correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt University Medical Center previously deployed clinical decision support (CDS) to decrease PIM prescribing rates, but recently transitioned to a new electronic health record (EHR). Objective  The goal of this study was to evaluate PIM prescribing rates for older adults before and after migration to the new EHR system. Methods  We reviewed prescribing rates of PIMs in adults 65 years and older, normalized per 100 total prescriptions from the legacy and new EHR systems between July 1, 2014 and December 31, 2019. The PIM prescribing rates before and after EHR migration during November 2017 were compared using a U-chart and Poisson regression model. Secondary analysis descriptively evaluated the frequency of prescriber acceptance rates in the new EHR. Results  Prescribing rates of PIMs decreased 5.2% (13.5 per 100 prescriptions to 12.8 per 100 prescriptions; p  
ISSN:1869-0327
1869-0327
DOI:10.1055/s-0040-1721398