# Evaluating a Prescribing Feedback System for Acute Care Providers

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

No systematic, automated process for providing feedback to acute care providers exists in the Veterans Health
Administration (VHA), despite there being 432,000 acute care visits annually by Veterans seeking acute
care via the emergency department (ED), urgent care clinics, or primary care clinics in the VHA. More
than 144 million prescriptions are written in these VHA acute care settings each year, many for antibiotics or
non-steroidal anti-inflammatory drugs (NSAIDs). More than 30% of acute care prescriptions for antibiotics
or NSAIDs are inappropriate and carry associated increased risk of adverse drug events (ADEs) due to lack
of patient or comorbidity familiarity, drug-drug interactions, and patient pressure to prescribe. Currently, acute
outpatient care providers operate without knowledge of their own prescribing quality or patient outcomes. This
absence of feedback creates a vacuum through which providers may falsely assume a positive outcome.
Inadequate outcomes feedback and understanding of indications and contraindications to prescribing
antibiotics and NSAIDs have hindered improvement in the quality and safety of prescriptions for Veteran in
acute care settings. We will use user-centered design to develop a scalable prescribing feedback system that
includes audit and feedback, academic detailing, and non-financial incentives, will be implemented to examine
how this multifaceted intervention impacts potentially inappropriate prescribing and ADEs in acute outpatient
care settings in the VHA.
This project describes a mixed-methods proposal that addresses major HSR&D priorities to improve Veteran
health and advance the VHA as a learning healthcare system. The Specific Aims are: 1) Evaluate
determinants of potentially inappropriate prescribing to design intervention implementation in acute outpatient
care settings.; 2) Develop and evaluate a risk-adjusted provider profiling surveillance system; 3) Refine the
visual representation of the feedback system with user-centered design; and 4) Examine the impact of
implementation of a multifaceted intervention on potentially inappropriate prescriptions and ADEs.
The team is uniquely qualified to accomplish these aims, with expertise in healthcare operations research,
informatics, human factors engineering and user-centered design, implementation science, qualitative
methods, and practicing clinicians in acute care settings (emergency department and primary care). The
institutional environment at the VA Tennessee Valley Healthcare System and Vanderbilt University Medical
Center is outstanding, including the Geriatric Research, Education and Clinical Center (GRECC), a site for VA
Quality Scholars, an innovative qualitative research center; nationally ranked graduate programs in the
relevant fields of study; and the national CTSA coordinating center.
This application will develop an automated feedback system for acute care providers using antibiotic and
NSAID prescribing as two exemplars of the need fo...

## Key facts

- **NIH application ID:** 10067710
- **Project number:** 1I01HX003057-01A2
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** MICHAEL E. MATHENY
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10067710

## Citation

> US National Institutes of Health, RePORTER application 10067710, Evaluating a Prescribing Feedback System for Acute Care Providers (1I01HX003057-01A2). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10067710. Licensed CC0.

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