Quality improvement toward decreasing high-risk medications for older veteran outpatients

Alan J. Zillich, Kenneth Shay, Barbara Hyduke, Thomas R. Emmendorfer, Alan M. Mellow, Steven R. Counsell, Mark A. Supiano, Peter Woodbridge, Pamela Reeves

Research output: Contribution to journalArticle

12 Scopus citations


OBJECTIVES: To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications. DESIGN: Single cohort, pre- and postintervention. SETTING: Regional network of Department of Veterans Affairs medical facilities. PARTICIPANTS: Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians. INTERVENTION: A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers. MEASUREMENTS: The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup. RESULTS: Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period (P<.001). Of the 801 patients in the subgroup, 72.0% (n=577) had high-risk medications discontinued (P<.001). CONCLUSION: This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.

Original languageEnglish (US)
Pages (from-to)1299-1305
Number of pages7
JournalJournal of the American Geriatrics Society
Issue number7
StatePublished - Jul 1 2008



  • Beers criteria
  • Geriatrics
  • Medication prescribing
  • Medication safety

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Zillich, A. J., Shay, K., Hyduke, B., Emmendorfer, T. R., Mellow, A. M., Counsell, S. R., Supiano, M. A., Woodbridge, P., & Reeves, P. (2008). Quality improvement toward decreasing high-risk medications for older veteran outpatients. Journal of the American Geriatrics Society, 56(7), 1299-1305. https://doi.org/10.1111/j.1532-5415.2008.01772.x