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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3054 — The Utilization of Inappropriate HEDIS Medications in Veterans Administration Community Living Centers

Dosa DMHyde SI, and Intrator O, Providence VAMC;

Objectives:
Community Living Centers (nursing homes) have been identified by the Institute of Medicine (2000) as the most common site for Adverse Drug Events (ADE) with over 800,000 estimated prescription related errors annually. Such errors in the long-term care environment have been associated with an unacceptably high degree of morbidity and mortality. A common error described in the literature is the utilization of high-risk medications in the elderly—a population most likely to experience morbidity relative to ADEs. The purpose of this study was therefore to evaluate the use of prescriptions classified by the Healthcare Effectiveness Data Information Set (HEDIS) as high-risk medications over time in VA Community Living Centers (CLCs) and to assess variability by VISN and institution.

Methods:
Nursing home Minimum Data Set records from calendar years 2004-2009 were merged with VA Decision Support System Pharmacy Data to identify residents of Community Living Centers who received at least one medication on the HEDIS high-risk list for the elderly.

Results:
Between 2004 and 2009, a total of 25,105 out of 186,986 (Average = 13.81%, SD = 5.93%) Veterans admitted to a CLC received at least one HEDIS high-risk medication. Annual proportion of CLC Veterans using HEDIS medications varied among CLCs from 3.6% to 44.2% and among VISNs from 7.2% (VISN22) to 22.6% (VISN10). Steady reduction in the use of high-risk medications was noted, however, between 2004 and 2009. In 2004, the average proportion of Veterans using HEDIS medications in any CLC was 15.0% (SD = 7.2, Min = 2.9%, Max = 47.1%); by 2009 the average rate was 6.4% (SD = 4.6; Min = 0.3%, Max = 30.6%).

Implications:
The utilization of high-risk medications at VA CLCs has improved over time, but more work needs to be conducted to determine if patient specific and/or facility factors predict utilization of HEDIS medications amongst CLC Veterans at high risk for ADEs.

Impacts:
The utilization of HEDIS high-risk medications in VA CLCs markedly decreased between 2004 and 2009. Despite the overall improvement, the significant variability noted among CLCs suggests that improvements are possible and can be achieved.


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