Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Veterans Affairs, VA Heartland Network (Veterans Integrated Service Network 15), Kansas City, Missouri, USA.
Clin Ther. 2023 Oct;45(10):928-934. doi: 10.1016/j.clinthera.2023.07.021. Epub 2023 Sep 9.
Polypharmacy is common in older adults, with almost 20% of older adults taking ≥10 medications. They are at great risk for adverse events related to potentially inappropriate medications (PIMs). Although evidence-based methods for deprescribing have been successful at reducing polypharmacy and improving quality of medication use, there are several challenges to implementing these methods on a large scale. VIONE, a medication deprescribing methodology, was developed to reduce polypharmacy and PIMs across the Veterans Health Administration (VHA). (VIONE stands for Vital, Important, Optional, Not indicated, and Every medication has an indication.) This study describes the tools created for implementation of VIONE and the dashboards used to track VIONE implementation and subsequent deprescribing across the VHA; their use and sustainment are examined in a health system-wide adoption of this deprescribing practice in a high reliability organization (HRO).
VIONE was disseminated by the VHA via the Diffusion of Excellence Initiative. Dissemination included an implementation toolkit and four dashboards that collect and display data from the electronic medical record to monitor utilization of VIONE, track medication discontinuations, and prospectively identify veterans who may be candidates for deprescribing.
Between 2016 and the present, VIONE has been adopted at >130 medical centers and influenced almost 700,000 unique patients. In addition, a total of >1.6 million medication orders have been discontinued by >15,000 providers.
The VIONE methodology and informatics tools were widely disseminated and successfully adopted and sustained nationally in a high reliability organization, leading to a reduction in PIM use by older adults and improved quality and patient safety. Future efforts should continue to consider ways to leverage electronic medical record data and other relevant informatics tools to provide customized clinical decision support to further medication optimization and deprescribing efforts.
老年人普遍存在多种用药情况，近 20%的老年人服用≥10 种药物。他们存在与潜在不适当药物（PIM）相关的不良事件的巨大风险。尽管基于证据的药物减用方法在减少多种用药和改善药物使用质量方面取得了成功，但在大规模实施这些方法方面存在一些挑战。VIONE 是一种药物减用方法学，旨在减少退伍军人健康管理局（VHA）的多种用药和 PIM。（VIONE 代表 Vital、Important、Optional、Not indicated 和 Every medication has an indication。）本研究描述了为实施 VIONE 创建的工具以及用于跟踪 VHA 内 VIONE 实施和随后减药的仪表板；在高可靠性组织（HRO）中，对这一减药实践进行了全系统的采用，考察了它们的使用和维持情况。
VHA 通过卓越传播倡议传播 VIONE。传播包括实施工具包和四个仪表板，这些工具包和仪表板从电子病历中收集和显示数据，以监测 VIONE 的使用情况，跟踪药物停药情况，并前瞻性地确定可能适合减药的退伍军人。
自 2016 年以来，VIONE 已在 130 多家医疗中心采用，影响了近 70 万独特患者。此外，共有超过 15000 名提供者共停止了超过 1600 万次药物医嘱。
VIONE 方法学和信息学工具在高可靠性组织中得到了广泛传播和成功采用和维持，导致老年人 PIM 使用减少，质量和患者安全性提高。未来的努力应继续考虑利用电子病历数据和其他相关信息学工具的方法，为进一步的药物优化和减药努力提供定制的临床决策支持。
