# Scaling E.Q.U.I.P.P.E.D. Clinical Decision Support

> **NIH AHRQ R18** · EMORY UNIVERSITY · 2020 · $393,426

## Abstract

Project Summary: Scaling E.Q.U.I.P.P.E.D. Clinical Decision Support
 Older adults are a vulnerable population at high risk for medication adverse drug events (ADEs),
especially when they are discharged from the Emergency Department (ED). More than half of older adults
discharged from the ED leave with a new prescription medication.1,2 The risk of receiving a new potentially
inappropriate medication (PIM) upon discharge from the ED ranges from 5.6%-13%.2-7 Prescribing new
medications for older patients outside the primary care setting increases chances for suboptimal
prescribing as well as ADEs, both major reasons for repeat ED visits, hospitalization or death.1-8
EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency
Department) is an innovative quality improvement initiative designed to reduce PIM prescribing for adults
aged 65 years and older.9 EQUIPPED’s three interventions together address the 5 Rights Framework
promoted by AHRQ: 1) provider education via didactic education; 2) electronic clinical decision support via
specialized geriatric pharmacy order sets and links to online educational content at point of prescribing;
and 3) academic detailing including audit and feedback and peer benchmarking. EQUIPPED is informed by
the Beers Criteria,10 widely used by government agencies and supported by research in various settings1,5,6
as a marker of prescribing quality.
 EQUIPPED has been successfully implemented in 11 urban and rural Veterans Affairs (VA) Medical
Centers using the Computerized Patient Record System electronic health record (EHR), with the first 4
sites reducing PIMs from 7.4%-11.9% of all medications at pre-implementation baseline to 4.5%-6.1% one
year post-implementation.11 It has further been implemented in 2 academic hospitals using the Epic EHR,
with the first site reducing the percentage of providers who prescribed zero (0) PIMs from 25/89 (28%) pre-
implementation to 61/89 (68%) 6 months post-implementation. With demonstrated effectiveness in 2 widely
used EHRs, we now propose to scale up EQUIPPED CDS in 2 ways. First, we will extend implementation
of EQUIPPED CDS to a new EHR, Cerner/Powerchart, thereby widening the scope of applicability to at
least 45% of the hospital EHR market outside the VA system.12 Second, we will effect local scale-up by
widening implementation from 1 academic hospital to 4 additional hospitals (including 2 community sites)
within a single health system.
 Specific Aim 1: Scale EQUIPPED CDS in two settings, Cerner/Powerchart EHR at Emory
University Hospital and three addition sites in the Mount Sinai ED system. Specific Aim 2: Evaluate
implementation scale-up using the RE-AIM (reach, effectiveness, adoption, implementation, and
maintenance) framework.

## Key facts

- **NIH application ID:** 9986801
- **Project number:** 5R18HS026877-02
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Ann E Vandenberg
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $393,426
- **Award type:** 5
- **Project period:** 2019-08-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9986801

## Citation

> US National Institutes of Health, RePORTER application 9986801, Scaling E.Q.U.I.P.P.E.D. Clinical Decision Support (5R18HS026877-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9986801. Licensed CC0.

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