QUERI – Quality Enhancement Research Initiative

MedSafe QUERI: Optimizing Appropriate Use of Medications for Veterans

Palo Alto, CA

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While VA has implemented many interventions to improve medication safety, medication management has significant room for improvement. Thus, optimization of medication use is the main theme of the MedSafe QUERI Program, with decision support and provider networks the focus of its implementation research. MedSafe QUERI will only recommend expansion or design interventions for care strategies that are considered to be of "reasonable" value (ratio of benefit and cost). The main goal of this QUERI program is to increase the use of high-value medications, decrease low-value medications, and improve the safety of high-risk medications through the following projects.

• Medication Use Evaluation Tracker (MUET) Program. Optimization and expansion of Pharmacy Benefits Management’s (PBM) existing MUET Program across all facilities in the 18 VISNs for five MUET projects: Dimethyl Fumarate White Blood Count Monitoring; Potassium Follow-Up in Heart Failure with New Mineralocorticoid Receptor Antagonist; Prasugrel or Ticagrelor >12 months; Women of Childbearing Age on Warfarin; and Direct Oral Anticoagulants
• Clinical Decision Support (CDS). Implementation of a CDS system for medications commonly prescribed in Primary Care by patient-aligned care teams (PACTs) at facilities within VISN 21.
• VISN 21 Pharmacy Dashboard. Determine optimal use of the VISN 21 Pharmacy Dashboard at all eight facilities in VISN 21 for four Dashboards: 1) Spironolactone/Eplerenone (diuretics), 2) Lithium Carbonate, 3) Hypoglycemia Safety Initiative, and 4) Oncology Medication Monitoring.

Findings and Impacts:

Conducted in collaboration with the VA PBM, a key impact from the findings for the MUET Project has been the joint development of a National Dashboard Advisory Committee for real-time risk identification and risk reduction tools. This Advisory Committee has begun identifying existing dashboards that address the issue for potential roll-out as national solution.

Principal Investigators: Paul Heidenreich, MD, MS, (Paul.Heidenreich@va.gov) and Mary Goldstein, MD (Mary.Goldstein@va.gov).

Operational Partners: VA’s Office of Pharmacy Benefits Management (PBM), VISN 21 PBM), VA Primary Care Services, and VA Specialty Care Services.