Facility-Level Variation in Potentially Inappropriate Prescribing for Older Veterans
Article first published online: 21 JUN 2012
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 60, Issue 7, pages 1222–1229, July 2012
How to Cite
Gellad, W. F., Good, C. B., Amuan, M. E., Marcum, Z. A., Hanlon, J. T. and Pugh, M. J. V. (2012), Facility-Level Variation in Potentially Inappropriate Prescribing for Older Veterans. Journal of the American Geriatrics Society, 60: 1222–1229. doi: 10.1111/j.1532-5415.2012.04042.x
- Issue published online: 12 JUL 2012
- Article first published online: 21 JUN 2012
- VA Career Development Award. Grant Number: CDA 09–207
- National Institute on Aging. Grant Numbers: P30AG024827, T32 AG021885, K07AG033174, R01AG034056, R56AG027017
- National Institute of Nursing Research. Grant Number: R01 NR010135
- Agency for Healthcare Research and Quality. Grant Numbers: K12 HS019461, VA HSR&D DHI 09–237 PI, VA HSR&D IIR-06–062 PI, VA HSR&D PPO 09–295, VA HSR&D IIR 02–274, VA HSR&D IIR 08–274, VA HSR&D SDR-07–042, IIR-05–121, IAF-06–080, IIR-09–335, SHP 08–140, TRX 01–091, CDMRP 09090014, R01 HS017695, R01 HS018721
- National Institutes of Health. Grant Numbers: VA HSR&D PPO 09–295, VA HSR&D IIR 02–274, VA HSR&D IIR 08–274, VA HSR&D SDR-07–042, IIR-05–121, IAF-06–080, IIR-09–335, SHP 08–140, TRX 01–091, CDMRP 09090014
- Epilepsy Foundation. Grant Numbers: VA HSR&D PPO 09–295, VA HSR&D IIR 02–274, VA HSR&D IIR 08–274, VA HSR&D SDR-07–042, IIR-05–121, IAF-06–080, IIR-09–335, SHP 08–140, TRX 01–091
- Department of Defense. Grant Numbers: R01-NR010828, CDMRP 09090014
- potentially inappropriate prescribing;
- HEDIS measures;
- quality of care;
To describe facility-level variation in two measures of potentially inappropriate prescribing prevalent in Veterans Affairs (VA) facilities—exposure to high-risk medications in elderly adults (HRME) and drug–disease interactions (Rx-DIS)—and to identify facility characteristics associated with high-quality prescribing.
VA Healthcare System.
Veterans aged 65 and older with at least one inpatient or outpatient visit in 2005–2006 (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).
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.
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) = 0.77–0.96) and iRx-DIS (OR = 0.95, 95% CI = 0.88–1.01). Patients seen in facilities caring for fewer older veterans had greater odds of iHRME (OR = 1.54, 95% CI = 1.35–1.75) and iRx-DIS exposure (OR = 1.22, 95% CI = 1.11–1.33).
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.