Pilot program aims to reduce adverse drug events in Rhode Island seniors by improving prescribing at emergency department discharge

PROVIDENCE, RI – Blue Cross & Blue Shield of Rhode Island (BCBSRI) is partnering with Brown Emergency Medicine on a pilot program to reduce adverse drug events, particularly in Rhode Island adults aged 65 or older. The EQUIPPED program, short for Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department, intends to reduce the prescribing of potentially inappropriate medications (PIMs) that could cause side effects for older patients and lead to preventable health care use.

The program was one of the winning submissions from BCBSRI’s Provider Medical Expense Trend (MET) Summit. The Summit invited proposals from provider partners on innovative ways to reduce rising and unnecessary medical costs through the identification, oversight, execution and monitoring of savings opportunities. Beyond keeping Rhode Island’s seniors healthier, EQUIPPED is also expected to provide education to emergency department physicians on medication safety and lower costs by reducing adverse drug events.

“This is the type of collaboration we hoped for when we held our first Provider MET Summit. I’m thrilled to see this important project move forward as it aligns with and supports our vision to passionately lead a state of health and well-being for all Rhode Islanders," said Matt Collins, M.D., vice president of clinical integration. “The American Geriatric Society finds that 35 percent of older adults experience an adverse drug event every year, accounting for one out of every three hospital admissions and resulting in estimated costs of $30 billion each year. Helping this population will go a long way toward improving their health and improving the impact to the healthcare system."

The EQUIPPED program in Rhode Island was launched by Elizabeth Goldberg, M.D., ScM, assistant professor of emergency medicine at Brown University, who says that the pilot aims to reduce PIMs by employing a model that combines education, individual provider feedback, and clinical decision support. The program was originally designed by Melissa Stevens, M.D., and Camille Vaughan, M.D., M.S., associate professors of medicine at Emory University, and has been implemented at 11 Veterans Affairs Medical Centers and three civilian hospitals. There has been a significant and sustained reduction in PIM use in almost all of their sites. This will be the first time the program has been launched in New England.

Through the implementation of this program, BCBSRI and Brown Emergency Medicine are expecting to see a 20 percent reduction in PIM use. Each year, adverse drug events account for more than 3.5 million physician office visits, 1 million emergency department visits and 125,000 hospital admissions.

“By 2040 the population of Rhode Islanders 65 and older is expected to double and we need to be proactive in addressing their health needs and reducing the risk they experience from the drugs we prescribe," said Goldberg.

EQUIPPED is informed by the American Geriatrics Society (AGS) Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The AGS Beers Criteria is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. EQUIPPED has already built a list of preferred medication for the geriatric population into the electronic health records (EHR) at Lifespan hospitals including Rhode Island, The Miriam and Newport hospitals. Order sets have been built directly into the EHR, so when a provider selects discharge on a patient record - based on what their diagnosis is – they can choose among medication that are safe and effective for older patients.

EQUIPPED’s combination of geriatric education, individual provider feedback and electronic decision support equips providers with the support needed to make safe and effective clinical decisions. Additionally, monthly report cards are shared with providers to assess their clinical interactions and the medications being prescribed to provide additional guidance to further improve processes.