Cover: Facility-level Variation in Potentially Inappropriate Prescribing for Older Veterans

Facility-level Variation in Potentially Inappropriate Prescribing for Older Veterans

Published In: Journal of the American Geriatrics Society, v. 60, no. 7, July 2012, p. 1222-1229

Posted on 2012

by Walid F. Gellad, Chester B. Good, Megan E. Amuan, Zachary A. Marcum, Joseph T. Hanlon, Mary Jo V. Pugh

Research Question

  1. Does the quality of prescribing for older veterans vary across Veterans Affairs facilities?

OBJECTIVES: To describe facility-level variation in two measures of potentially inappropriate prescribing prevalent in Veterans Affairs (VA) facilities—exposure to high-risk medications in elderly adults (HRME) and drug–disease interactions (Rx-DIS)—and to identify facility characteristics associated with high-quality prescribing. DESIGN: Cross-sectional. SETTING: VA Healthcare System. PARTICIPANTS: Veterans aged 65 and older with at least one inpatient or outpatient visit in 2005–2006 (N = 2,023,477; HRME exposure) and a subsample with a history of falls or hip fractures, dementia, or chronic renal failure (n = 305,059; Rx-DIS exposure). MEASUREMENTS: Incident use of any HRME (iHRME) and incident Rx-DIS (iRx-DIS) and facility-level rates and facility-level predictors of iHRME and iRx-DIS exposure, adjusting for differences in patient characteristics. RESULTS: Overall, 94,692 (4.7%) veterans had iHRME exposure. At the facility level, iHRME exposure ranged from 1.6% at the lowest facility to 12.8% at the highest (median 4.7%). In the subsample, 9,803 (3.2%) veterans had iRx-DIS exposure, with a facility-level range from 1.3% to 5.8% (median 3.2%). In adjusted analyses, veterans seen in facilities with formal geriatric education had lower odds of iHRME (odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.77–0.96) and iRx-DIS (OR = 0.95, 95% CI = 0.88–1.01). Patients seen in facilities caring for fewer older veterans had greater odds of iHRME (OR = 1.54, 95% CI = 1.35–1.75) and iRx-DIS exposure (OR = 1.22, 95% CI = 1.11–1.33). CONCLUSION: Substantial variation in the quality of prescribing for older adults exists across VA facilities, even after adjusting for patient characteristics. Higher-quality prescribing is found in facilities caring for a larger number of older veterans and facilities with formal geriatric education.

Key Findings

The quality of prescribing for older veterans varies across Veterans Affairs (VA) facilities.

  • Veterans seen at facilities that care for a larger number of older patients and have formal geriatric education have higher quality prescribing.

This report is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.