Funded Projects
Optimizing Prescribing Decisions for Hospitalized Older Adults with Chronic Conditions
Summary: Over 7 million adults older adults are hospitalized in the US annually and older adults are often discharged with changes to medications for chronic conditions which are not directly related to their reason for hospitalization. In current practice, neither prior chronic disease control nor key geriatric issues such as multimorbidity, polypharmacy, or cognition appear to influence discharge prescribing decisions, thus, there is an urgent need to reorient the current approach to hospital management of older adults’ chronic conditions from a number- driven to a patient-centered decision-making process. With this proposed project, we will develop and pilot test an innovative clinical decision framework which will incorporate geriatric principles to individualize chronic medication discharge prescribing decisions for hospitalized older adults, thereby improving the health and wellbeing of older adults in the peri-hospitalization period.
Principal Investigator: Timothy Anderson
Funding Institute: National Institute on Aging, K76AG074878
Prescribing Wisely Lab Focus Area(s): Hospital Prescribing, Prescribing Quality
Characterizing Opioid-related Adverse Events in Older Adults After Hospital Discharge
Summary: For the more than 12 million adults age 65 and older hospitalized each year in the United States, medications are the leading cause of significant, unintended harm as they transition back to the community. Opioids are prescribed to millions of older adults after hospital discharge each year, and are consistently identified as one of the top causes of unintended medication-related harm. The proposed studies will lead to a better understanding of the specific nature of opioid-related patient harm after hospital discharge, identify factors that place patients at highest risk for such harm, and inform development of improvements in healthcare systems to reduce the incidence and consequences of these potentially devastating events for older adults.
Principal Investigator: Shoshana Herzig
Funding Institute: Agency for Healthcare Research and Quality, 5R01HS026215
Prescribing Wisely Lab Focus Area(s): Hospital Prescribing, Prescribing Quality
Pilot of a Brief Cognitive Behavioral Therapy Intervention to Enhance Benzodiazepine Deprescribing in Older Adults
Summary: Benzodiazepines have been identified as potentially inappropriate medications due to their association with increased health risks especially in older adults. It is important to create successful models for patient-centered describing to prevent severe withdrawal symptoms or mental health crises. One frequently identified psychological predictor for successful benzodiazepine discontinuation is self-efficacy. There are two study aims. The first aim is to refine, based on stakeholder feedback, a novel, brief telehealth intervention consisting of psychologist-led third-wave cognitive behavioral therapy sessions focused on reducing fears and improving self-efficacy related to deprescribing integrated within a pharmacist-led benzodiazepine tapering program. The second aim is to evaluate the feasibility and acceptability of the refined deprescribing intervention using mixed methods. Study Design: Single-arm pilot trial of the refined brief cognitive behavioral therapy-assisted deprescribing intervention in 20 older adults prescribed chronic benzodiazepines. By collecting quantitative data during the trial and qualitative interviews of participants at the end of the intervention, we will further refine the intervention in preparation for larger scale testing and implementation.
Principal Investigators: Timothy Anderson, Gloria Yeh
Funding Institute: US Deprescribing Research Network, R24AG064025
Prescribing Wisely Lab Focus Area(s): Deprescribing
Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain
Summary: In the US, little is known about patient and clinician views on deprescribing chronic opioids among older adults. In this project, qualitative methods are used to explore older adults’ perspectives and experiences with reducing long-term opioid use and primary care practitioners (PCPs) communication and decision-making around deprescribing long-term opioids. We aim to use this information to develop strategies to support communication between PCPs and older adults around deprescribing opioids. Outcomes include shared and conflicting themes between patients and PCPs regarding perceptions of opioid prescribing and barriers to deprescribing
Principal Investigators: Timothy Anderson
Funding Institute: US Deprescribing Research Network, R24AG064025
Prescribing Wisely Lab Focus Area(s): Deprescribing
Impact of Medicare’s Transitional Care Management Program on Clinical Outcomes Following Cardiovascular Hospitalizations
Summary: The objectives of this grant are to assess the uptake of Transitional Care Management (TCM) services by eligible Medicare beneficiaries following hospitalization for acute myocardial infarction or heart failure and to determine the real-world impact of TCM on post-discharge primary care and cardiology follow up and clinical outcomes.
Principal Investigators: Timothy Anderson
Funding Institute: American Heart Association, CDA940950
Prescribing Wisely Lab Focus Area(s): Hospital Prescribing
Characterizing the Quality of Evidence-based Prescribing for Hospitalized Veterans
Summary: The objectives of this proposal are to measure and understand determinants of prescribing quality for hospitalized Veterans and to identify evidence-based strategies to improve evidence-based prescribing. Developed in partnership with the VA National Hospital Medicine Program, Office of Health Equity, and Center for Medication Safety this project will apply Learning Health Systems foundational methods to achieve the VA Quintuple Aims of improving outcomes and ensuring equity. The results of this proposal will provide hospital-specific metrics to frontline clinicians and administrators to guide quality improvement efforts to advance inpatient prescribing quality.
Principal Investigators: Timothy Anderson
Funding Institute: U.S. Department of Veterans Affairs, HSR2-004-24W
Prescribing Wisely Lab Focus Area(s): Hospital Prescribing, Prescribing Quality