Screening Tool of Older Person's Prescriptions

Screening Tools to Alert Doctors to Right Treatment Medication Criteria Modified for U.S. Nursing Home Setting

Published in: Journal of American Geriatrics Society, [Epub December 2016], doi 10.1111/jgs.14689

Posted on on March 15, 2017

by Dmitry Khodyakov, Aileen Ochoa, Brianne L. Olivieri-Mui, Carla Bouwmeester, Barbara Zarowitz, Meenakshi Patel, Diana Ching, Becky Briesacher

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This article was published outside of RAND. The full text of the article can be found at the link above.


To develop a set of prescribing indicators measurable with available data from electronic nursing home (NH) databases by adapting the European-based 2014 Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tools to Alert Doctors to Right Treatment (START) criteria of potentially inappropriate and underused medications for the U.S.


A two-stage expert panel process. In the first stage, the investigator team reviewed 114 criteria for compatibility and measurability. In the second stage, an online modified e-Delphi (OMD) panel was convened to rate the validity of criteria, and two webinars were held to identify criteria with highest relevance to U.S. NHs.


Seventeen experts with recognized reputations in NH care participated in the e-Delphi panel and 12 in the webinar.


Compatibility and measurability were assessed by comparing criteria with U.S. terminology and setting standards and data elements in NH databases. Validity was rated using a 9-point Likert-type scale (1 = not valid at all, 9 = highly valid). Mean, median, interpercentile ranges, and agreement were determined for each criterion score. Relevance was determined by ranking the mean panel ratings on criteria that reached agreement; the webinar participants reviewed and approved half of the criteria with the highest mean values.


Fifty-three STOPP/START criteria were deemed to be compatible with the U.S. NH setting and measurable using data from electronic NH databases. E-Delphi panelists rated 48 criteria as valid for U.S. NHs. Twenty-four criteria were deemed to be most relevant, consisting of 22 measures of potentially inappropriate medications and two measures of underused medications.


This study created the first explicit criteria for assessing the quality of prescribing in U.S. NHs.

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