{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:30:46Z","timestamp":1761561046082,"version":"build-2065373602"},"reference-count":47,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015620","name":"Center for Innovations in Quality, Effectiveness and Safety","doi-asserted-by":"publisher","award":["CIN 13\u2013413"],"award-info":[{"award-number":["CIN 13\u2013413"]}],"id":[{"id":"10.13039\/100015620","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS024437"],"award-info":[{"award-number":["R01HS024437"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Joint Commission Journal on Quality and Patient Safety"],"published-print":{"date-parts":[[2022,4]]},"DOI":"10.1016\/j.jcjq.2022.01.003","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:06:49Z","timestamp":1642032409000},"page":"222-232","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Potentially Harmful Medication Dispenses After a Fall or Hip Fracture: A Mixed Methods Study of a Commonly Used Quality Measure"],"prefix":"10.1016","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5343-0002","authenticated-orcid":false,"given":"Heidi","family":"Fischer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8419-2331","authenticated-orcid":false,"given":"Erin E.","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonnie H.","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7252-8934","authenticated-orcid":false,"given":"Corrine E.","family":"Munoz-Plaza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5825-9248","authenticated-orcid":false,"given":"Tiffany Q.","family":"Luong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa N.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6108-9198","authenticated-orcid":false,"given":"Jeff M.","family":"Slezak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-8243","authenticated-orcid":false,"given":"John J.","family":"Sim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian S.","family":"Mittman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6049-4052","authenticated-orcid":false,"given":"Eric Anthony","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1019-9311","authenticated-orcid":false,"given":"Michael H.","family":"Kanter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristi","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1139-6496","authenticated-orcid":false,"given":"Kim N.","family":"Danforth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.jcjq.2022.01.003_bib0001","unstructured":"World Health Organization. Falls. Apr 26, 2021. Accessed Jan 19, 2022. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/falls."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0002","unstructured":"World Health Organization. WHO Global Report on Falls Prevention in Older Age. 2007. Accessed Jan 19, 2022. https:\/\/www.who.int\/ageing\/publications\/Falls_prevention7March.pdf."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0003","unstructured":"Centers for Disease Control and Prevention. Important Facts About Falls. Feb 10, 2017. Accessed Jan 19, 2022. https:\/\/www.cdc.gov\/homeandrecreationalsafety\/falls\/adultfalls.html."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0004","doi-asserted-by":"crossref","first-page":"509","DOI":"10.15585\/mmwr.mm6718a1","article-title":"Deaths from falls among persons aged \u226565 years\u2014United States, 2007\u20132016","volume":"67","year":"2018","journal-title":"MMWR Morb Moral Wkly Rep"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0005","unstructured":"US Census Bureau. 65 and Older Population Grows Rapidly as Baby Boomers Age. Jun 25, 2020. Accessed Jan 19, 2022. https:\/\/www.census.gov\/newsroom\/press-releases\/2020\/65-older-population-grows.html."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0006","unstructured":"US Census Bureau. An Aging Nation: the Older Population in the United States. Ortman JM, Velkoff VA, Hogan H. May 2014. Accessed Jan 19, 2022. https:\/\/www.census.gov\/content\/dam\/Census\/library\/publications\/2014\/demo\/p25-1140.pdf."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0007","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1001\/archinternmed.2009.357","article-title":"Meta-analysis of the impact of 9 medication classes on falls in elderly persons","volume":"169","author":"Woolcott","year":"2009","journal-title":"Arch Intern Med"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0008","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1532-5415.1999.tb01898.x","article-title":"Drugs and falls in older people: a systematic review and meta-analysis: I. psychotropic drugs","volume":"47","author":"Leipzig","year":"1999","journal-title":"J Am Geriatr Soc"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0009","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/oxfordjournals.aje.a117619","article-title":"Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents","volume":"142","author":"Thapa","year":"1995","journal-title":"Am J Epidemiol"},{"year":"2015","series-title":"HEDIS 2015: Healthcare Effectiveness Data and Information Set, vol 2","key":"10.1016\/j.jcjq.2022.01.003_bib0010"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0011","unstructured":"National Committee for Quality Assurance. HEDIS Measures and Technical Resources Accessed Jan 19, 2022. https:\/\/www.ncqa.org\/hedis\/measures\/."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0012","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1111\/j.1532-5415.2011.03524.x","article-title":"Exposure to Potentially harmful drug-disease interactions in older community-dwelling veterans based on the Healthcare Effectiveness Data and Information Set quality measure: who is at risk?","volume":"59","author":"Pugh","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0013","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/jgs.13197","article-title":"Epidemiology of drug-disease interactions in older veteran nursing home residents","volume":"63","author":"Aspinall","year":"2015","journal-title":"J Am Geriatr Soc"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0014","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/jgs.15767","volume":"67","year":"2019","journal-title":"J Am Geriatr Soc."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0015","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/jcpt.12502","article-title":"Potential drug\u2013drug and drug\u2013disease interactions in well-functioning community-dwelling older adults","volume":"42","author":"Hanlon","year":"2017","journal-title":"J Clin Pharm Ther"},{"issue":"3","key":"10.1016\/j.jcjq.2022.01.003_bib0016","doi-asserted-by":"crossref","first-page":"37","DOI":"10.7812\/TPP\/12-031","article-title":"Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data","volume":"16","author":"Koebnick","year":"2012","journal-title":"Perm J"},{"issue":"4","key":"10.1016\/j.jcjq.2022.01.003_bib0017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v047.i04","article-title":"frailtypack: an R package for the analysis of correlated survival data with frailty models using penalized likelihood estimation or parametrical estimation","volume":"47","author":"Rondeau","year":"2012","journal-title":"J Stat Softw"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0018","first-page":"119","article-title":"Approximate is better than \u201cexact\u201d for interval estimation of binomial proportions","volume":"52","author":"Agresti","year":"1998","journal-title":"Am Stat"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0019","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1136\/qshc.2004.011155","article-title":"Making psychological theory useful for implementing evidence based practice: a consensus approach","volume":"14","author":"Michie","year":"2005","journal-title":"Qual Saf Health Care"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0020","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","article-title":"A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems","volume":"12","author":"Atkins","year":"2017","journal-title":"Implement Sci"},{"year":"2019","series-title":"Proposed Changes to Existing Measures for HEDIS\u00ae 2020: Use of High-Risk Medications in the Elderly (DAE) and Potentially Harmful Drug-Disease Interactions in the Elderly (DDE)","key":"10.1016\/j.jcjq.2022.01.003_bib0021"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0022","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1111\/1475-6773.12562","article-title":"Determinants of potentially inappropriate medication use among community-dwelling older adults","volume":"52","author":"Miller","year":"2017","journal-title":"Health Serv Res"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0023","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3390\/pharmacy7020041","article-title":"Race\/ethnicity, socioeconomic status, and polypharmacy among older Americans","volume":"7","author":"Assari","year":"2019","journal-title":"Pharmacy (Basel)"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0024","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.maturitas.2013.02.009","article-title":"Risk factors for falls among older adults: a review of the literature","volume":"75","author":"Ambrose","year":"2013","journal-title":"Maturitas"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0025","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2165\/11599460-000000000-00000","article-title":"Medication-related falls in the elderly: causative factors and preventive strategies","volume":"29","author":"Huang","year":"2012","journal-title":"Drugs Aging"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0026","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1177\/0898264310381277","article-title":"Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis","volume":"23","author":"Bloch","year":"2011","journal-title":"J Aging Health"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0027","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.amepre.2018.05.026","article-title":"Low systolic blood pressure from treatment and association with serious falls\/syncope","volume":"55","author":"Sim","year":"2018","journal-title":"Am J Prev Med"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0028","unstructured":"Centers for Disease Control and Prevention. STEADI\u2014Older Adult Fall Prevention. Jul 26, 2021. Accessed Jan 19, 2022. https:\/\/www.cdc.gov\/steadi\/index.html."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0029","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1001\/jama.2019.5453","article-title":"Hip fractures in older adults in 2019","volume":"321","author":"Berry","year":"2019","journal-title":"JAMA"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0030","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1001\/jama.2018.3097","article-title":"US Preventive Services Task Force. Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement","volume":"319","year":"2018","journal-title":"JAMA"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0031","doi-asserted-by":"crossref","first-page":"3015","DOI":"10.1007\/s11606-020-06493-8","article-title":"Patient and physician perspectives of deprescribing potentially inappropriate medications in older adults with a history of falls: a qualitative study","volume":"36","author":"Hahn","year":"2021","journal-title":"J Gen Intern Med"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0032","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1001\/jama.2018.16473","article-title":"Overcoming inertia to improve medication use and deprescribing","volume":"320","author":"Steinman","year":"2018","journal-title":"JAMA"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0033","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1001\/jamainternmed.2016.4814","article-title":"Patterns of prescription drug use before and after fragility fracture","volume":"176","author":"Munson","year":"2016","journal-title":"JAMA Intern Med"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0034","first-page":"142","article-title":"Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial","volume":"46","author":"Boy\u00e9","year":"2017","journal-title":"Age Ageing"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0035","doi-asserted-by":"crossref","first-page":"23","DOI":"10.5694\/j.1326-5377.2007.tb01110.x","article-title":"A Quality Use of Medicines program for general practitioners and older people: a cluster randomised controlled trial","volume":"187","author":"Pit","year":"2007","journal-title":"Medical J Aust"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0036","first-page":"129","article-title":"Patient activation related to fall prevention: a multisite study","volume":"46","author":"Christiansen","year":"2020","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0037","first-page":"403","article-title":"Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit","volume":"43","author":"Dykes","year":"2017","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0038","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1001\/jama.2018.16131","article-title":"Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial","volume":"320","author":"Martin","year":"2018","journal-title":"JAMA"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0039","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1370\/afm.1838","article-title":"Effectiveness of a multifaceted intervention for potentially inappropriate prescribing in older patients in primary care: a cluster-randomized controlled trial (OPTI-SCRIPT study)","volume":"13","author":"Clyne","year":"2015","journal-title":"Ann Fam Med"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0040","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1186\/s12913-020-05108-6","article-title":"Emergency department-based medication review on outpatient health services utilization: interrupted time series","volume":"20","author":"Kitchen","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0041","unstructured":"Centers for Medicare & Medicaid Services, Medicare Learning Network. Medicare Wellness Visits. (Updated: Feb 2021.) Accessed Jan 19, 2022. https:\/\/www.cms.gov\/Outreach-and-Education\/Medicare-Learning-Network-MLN\/MLNProducts\/preventive-services\/medicare-wellness-visits.html."},{"key":"10.1016\/j.jcjq.2022.01.003_bib0042","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s11914-008-0026-4","article-title":"Falls: epidemiology, pathophysiology, and relationship to fracture","volume":"6","author":"Berry","year":"2008","journal-title":"Curr Osteoporos Rep"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0043","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s00198-018-4732-1","article-title":"Risk of subsequent fracture after prior fracture among older women","volume":"30","author":"Balasubramanian","year":"2019","journal-title":"Osteoporos Int"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0044","first-page":"1056","article-title":"Electronic clinical surveillance to improve outpatient care: diverse applications within an integrated delivery system","volume":"2","author":"Danforth","year":"2014","journal-title":"EGEMS (Wash DC)"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0045","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jbi.2017.01.009","article-title":"User-centered design improves the usability of drug-drug interaction alerts: experimental comparison of interfaces","volume":"66","author":"Luna","year":"2017","journal-title":"J Biomed Inform"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0046","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12911-017-0430-8","article-title":"Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system","volume":"17","author":"Ancker","year":"2017","journal-title":"BMC Med Inform Decis Mak"},{"key":"10.1016\/j.jcjq.2022.01.003_bib0047","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jagp.2013.01.008","article-title":"The complex interplay of depression and falls in older adults: a clinical review","volume":"21","author":"Iaboni","year":"2013","journal-title":"Am J Geriatr Psychiatry"}],"container-title":["The Joint Commission Journal on Quality and Patient Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1553725022000034?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1553725022000034?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:01:34Z","timestamp":1761559294000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1553725022000034"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["S1553725022000034"],"URL":"https:\/\/doi.org\/10.1016\/j.jcjq.2022.01.003","relation":{},"ISSN":["1553-7250"],"issn-type":[{"type":"print","value":"1553-7250"}],"subject":[],"published":{"date-parts":[[2022,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Potentially Harmful Medication Dispenses After a Fall or Hip Fracture: A Mixed Methods Study of a Commonly Used Quality Measure","name":"articletitle","label":"Article Title"},{"value":"The Joint Commission Journal on Quality and Patient Safety","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jcjq.2022.01.003","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 The Joint Commission. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}