# Optimizing Appropriate Use of Medications for Veterans

> **NIH VA IP1** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

We have selected optimization of medication use as the main theme of our QUERI Program with decision
support and provider networks as foci of implementation. Our proposal will build upon existing strong
relationships between the project leads (who have a long history of conducting successful QUERI projects),
and our operations partners including Pharmacy Benefits Management (PBM), Primary Care (PC), and
Specialty Care Services.
Primary Program Goal: To optimize medication management in the VA general and Patient Aligned Care
Teams in particular using pharmacy networks and decision support tools.
While the VA has implemented many interventions to improve medication safety, medication management has
significant room for improvement. Several recommendations by the Institute of Medicine, including the wide
availability of decision support and more pharmacy involvement in prescribing have not been widely
implemented in the VA. In 2011, 12% of Veterans were prescribed a potentially inappropriate medication with
an incidence (new inappropriate medication) of 6% per year. A large variation in the quality of medication
prescribing has been noted in the VA which is comparable to the general population. There is also variation in
quality of prescribing across disease states in the VA.
Associated Goal: Value: Our underlying principle is to promote high value clinical care with all medication
related interventions. We will only recommend expansion of, or design interventions for, care strategies that
are considered a “reasonable” value (ratio of benefit and cost). We plan to improve use of high value
medications, decrease use of low-value medications and improve medication safety through:
 1) Optimization and expansion of the Medication Use Evaluation Tracker (MUET) of PBM. (Project 1)
 2) Implementation of Clinical Decision Support for medications commonly prescribed in PC. (Project 2)
 3) Local One-Year Project: Determine optimal use of the VISN 21 Pharmacy Dashboard targeting Patient
 Aligned Care Teams. (Project 3)
These projects include both innovation (clinical decision support, use of communities of practice, development
of a new Medication Use Evaluation Tracker) and evaluation of existing implementation practices. By taking
advantage of natural experiments that have occurred as different facilities implemented the MUET program
and VISN 21 Pharmacy Dashboard differently, we will be able to examine effectiveness and value of a variety
of implementation strategies.
Implementation Science Focus: Our chosen area of focus for implementation is the use of provider
networks. As described below in the Implementation Core Section, through our prior QUERI work we have
shown (in a randomized trial) how QUERI facilitation of a provider network can be successful in rolling out a
national initiative (Hospital to Home) in the VA health system. Our results demonstrate that Provider networks
can complement top down implementation strategies to improve care for Veteran...

## Key facts

- **NIH application ID:** 10200823
- **Project number:** 5IP1HX002261-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** MARY K. Goldstein
- **Activity code:** IP1 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2016-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10200823

## Citation

> US National Institutes of Health, RePORTER application 10200823, Optimizing Appropriate Use of Medications for Veterans (5IP1HX002261-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10200823. Licensed CC0.

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