Medication
overuse
The overuse of some medications can cause harm. For example, benzodiazepine medications, which are commonly prescribed for sleep and anxiety, can contribute to falls and memory loss in older adults. We develop and test strategies to assist patients and providers in decreasing or stopping the use of potentially inappropriate medications in cases where they could be harmful, a process known as de-prescribing. Our qualitative and interventional research has focused mainly on the use of electronic health record tools to assist with the de-prescribing processes. The following projects are a few examples of our work.
nudge-ehr
Novel Uses of adaptive Designs to Guide provider Engagement in EHRs
Pragmatic randomized controlled trials of EHR decision support to reduce inappropriate prescribing for older adults that uses an adaptive study design that allows for rapid within trial learning and design modification.
Funded by: NIH/NIA R33AG057388
spine care
Spine Pain INtervention to Enhance Care quality And Reduce Expenditure
A cluster randomized controlled multi-centered pragmatic clinical trial that tested several different care models intended to reduce the use of low-value interventions, such as opioids and invasive treatments, for patients with uncomplicated acute and subacute spine pain.
Funded by: Stanford University
sIMULATION
Overcoming Decisional Gaps in High-Risk Prescribing by Junior Physicians Using Simulation-Based Training
A 2-arm pragmatic randomized controlled trial of first-year medical resident physicians that tested the effect of individual simulation training on prescribing rates of high-risk medications to older adults.
Funded by: NIH/NIA P30AG064199
EHR TOOLS IN ADRD
Reducing cognitive decline in patients with mild cognitive impairment and
Alzheimer’s Disease and related dementias by developing and testing
clinician and caregiver deprescribing tools
Development and pilot testing of electronic health record (EHR)-based deprescribing tools for primary care providers caring for patients with mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD) that incorporate caregiver engagement to support safer prescribing decisions.
Funded by: NIH/NIA R21AG075928