Facility-Level Variation in Potentially Inappropriate Prescribing for Older Veterans

作者：Gellad Walid F^*; Good Chester B; Amuan Megan E; Marcum Zachary A; Hanlon Joseph T; Pugh Mary Jo V

来源：Journal of the American Geriatrics Society, 2012, 60(7): 1222-1229.

DOI：10.1111/j.1532-5415.2012.04042.x

• potentially inappropriate prescribing
• HEDIS measures
• quality of care
• pharmacoepidemiology

Objectives To describe facility-level variation in two measures of potentially inappropriate prescribing prevalent in Veterans Affairs (VA) facilitiesexposure to high-risk medications in elderly adults (HRME) and drugdisease interactions (Rx-DIS)and to identify facility characteristics associated with high-quality prescribing. Design Cross-sectional. Setting VA Healthcare System. Participants Veterans aged 65 and older with at least one inpatient or outpatient visit in 20052006 (N = 2,023,477; HRME exposure) and a subsample with a history of falls or hip fractures, dementia, or chronic renal failure (n = 305,059; Rx-DIS exposure). Measurements Incident use of any HRME (iHRME) and incident Rx-DIS (iRx-DIS) and facility-level rates and facility-level predictors of iHRME and iRx-DIS exposure, adjusting for differences in patient characteristics. Results Overall, 94,692 (4.7%) veterans had iHRME exposure. At the facility level, iHRME exposure ranged from 1.6% at the lowest facility to 12.8% at the highest (median 4.7%). In the subsample, 9,803 (3.2%) veterans had iRx-DIS exposure, with a facility-level range from 1.3% to 5.8% (median 3.2%). In adjusted analyses, veterans seen in facilities with formal geriatric education had lower odds of iHRME (odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.770.96) and iRx-DIS (OR = 0.95, 95% CI = 0.881.01). Patients seen in facilities caring for fewer older veterans had greater odds of iHRME (OR = 1.54, 95% CI = 1.351.75) and iRx-DIS exposure (OR = 1.22, 95% CI = 1.111.33). Conclusion Substantial variation in the quality of prescribing for older adults exists across VA facilities, even after adjusting for patient characteristics. Higher-quality prescribing is found in facilities caring for a larger number of older veterans and facilities with formal geriatric education.

• 出版日期2012-7