Scaling the EQUIPPED medication safety program: Traditional and hub-and-spoke implementation models

Area of Science:

• Geriatric Medicine
• Health Services Research
• Medication Safety

Background:

• The EQUIPPED program is an evidence-based initiative to decrease potentially inappropriate medications (PIMs) in older adults (65+) discharged from Emergency Departments (EDs).
• Scaling the EQUIPPED program involved a traditional model at one ED and a hub-and-spoke model at three other EDs within a health system.

Purpose of the Study:

• To evaluate the effectiveness of scaling the EQUIPPED program using traditional and hub-and-spoke implementation models.
• To determine if the hub-and-spoke model increased implementation speed without compromising PIM reduction or site engagement.

Main Methods:

• A comparative evaluation of PIM rates before and after EQUIPPED implementation over 12-month periods.
• Assessment of implementation duration, facilitators, and barriers across different ED sites and models.
• Analysis of prescribing data and qualitative interview data to understand implementation experiences.

Main Results:

• All four sites demonstrated a significant reduction in PIMs post-EQUIPPED implementation.
• Implementation time was comparable across both traditional and hub-and-spoke models.
• The hub-and-spoke model faced disproportionate engagement barriers at spoke sites due to champion role scope.

Conclusions:

• The EQUIPPED program was successfully implemented in four new sites during the COVID-19 pandemic using both models.
• The hub-and-spoke model is a viable strategy for scaling EQUIPPED, though no speed or quality advantage was observed.
• Adaptability of EQUIPPED to complex, real-world settings is confirmed.