{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T04:17:17Z","timestamp":1783829837178,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:00:00Z","timestamp":1705968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R18 HS0 26877"],"award-info":[{"award-number":["R18 HS0 26877"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence\u2010informed quality improvement initiative to reduce potentially inappropriate medications (PIMs) prescribed by Emergency Department (ED) providers to adults aged 65 and older at discharge. We aimed to scale\u2010up this successful program using (1) a traditional implementation model at an ED with a novel electronic medical record and (2) a new hub\u2010and\u2010spoke implementation model at three new EDs within a health system that had previously implemented EQUIPPED (hub). We hypothesized that implementation speed would increase under the hub\u2010and\u2010spoke model without cost to PIM reduction or site engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated the effect of the EQUIPPED program on PIMs for each ED, comparing their 12\u2010month baseline to 12\u2010month post\u2010implementation period prescribing data, number of months to implement EQUIPPED, and facilitators and barriers to implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The proportion of PIMs at all four sites declined significantly from pre\u2010 to post\u2010EQUIPPED: at traditional site 1 from 8.9% (8.1\u20139.6) to 3.6% (3.6\u20139.6) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); at spread site 1 from 12.2% (11.2\u201313.2) to 7.1% (6.1\u20138.1) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); at spread site 2 from 11.3% (10.1\u201312.6) to 7.9% (6.4\u20138.8) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045); and at spread site 3 from 16.2% (14.9\u201317.4) to 11.7% (10.3\u201313.0) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Time to implement was equivalent at all sites across both models. Interview data, reflecting a wide scope of responsibilities for the champion at the traditional site and a narrow scope at the spoke sites, indicated disproportionate barriers to engagement at the spoke sites.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EQUIPPED was successfully implemented under both implementation models at four new sites during the COVID\u201019 pandemic, indicating the feasibility of adapting EQUIPPED to complex, real\u2010world conditions. The hub\u2010and\u2010spoke model offers an effective way to scale\u2010up EQUIPPED though a speed or quality advantage could not be shown.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18746","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T09:01:06Z","timestamp":1706000466000},"page":"2184-2194","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Scaling the\n                    <scp>EQUIPPED<\/scp>\n                    medication safety program: Traditional and hub\u2010and\u2010spoke implementation models"],"prefix":"10.1111","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6319-4872","authenticated-orcid":false,"given":"Ann E.","family":"Vandenberg","sequence":"first","affiliation":[{"name":"Division of Geriatrics &amp; Gerontology, Department of Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3715-3073","authenticated-orcid":false,"given":"Ula","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine NYU Grossman School of Medicine  New York New York USA"},{"name":"James J. Peters VA Medical Center GRECC  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamie","family":"Das","sequence":"additional","affiliation":[{"name":"Division of Geriatrics &amp; Gerontology, Department of Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9836-2477","authenticated-orcid":false,"given":"Nicholas","family":"Genes","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine NYU Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylviah","family":"Nyamu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5425-1601","authenticated-orcid":false,"given":"Lynne","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0271-1407","authenticated-orcid":false,"given":"Ugo","family":"Ezenkwele","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3567-8308","authenticated-orcid":false,"given":"Eric","family":"Legome","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6825-8161","authenticated-orcid":false,"given":"Christopher","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Belachew","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2347-4260","authenticated-orcid":false,"given":"Traci","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4898-5454","authenticated-orcid":false,"given":"Michelle","family":"Kegler","sequence":"additional","affiliation":[{"name":"Department of Behavioural, Social and Health Education Sciences, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6713-794X","authenticated-orcid":false,"given":"Camille P.","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Division of Geriatrics &amp; 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