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

Ann E. Vandenberg, Ula Hwang, Shamie Das, Nicholas Genes, Sylviah Nyamu, Lynne Richardson, Ugo Ezenkwele, Eric Legome, Christopher Richardson, Adam Belachew, Traci Leong, Michelle Kegler, Camille P. Vaughan

Research output: Contribution to journalArticlepeer-review


Background: The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence-informed 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-up this successful program using (1) a traditional implementation model at an ED with a novel electronic medical record and (2) a new hub-and-spoke 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-and-spoke model without cost to PIM reduction or site engagement. Methods: We evaluated the effect of the EQUIPPED program on PIMs for each ED, comparing their 12-month baseline to 12-month post-implementation period prescribing data, number of months to implement EQUIPPED, and facilitators and barriers to implementation. Results: The proportion of PIMs at all four sites declined significantly from pre- to post-EQUIPPED: at traditional site 1 from 8.9% (8.1–9.6) to 3.6% (3.6–9.6) (p < 0.001); at spread site 1 from 12.2% (11.2–13.2) to 7.1% (6.1–8.1) (p < 0.001); at spread site 2 from 11.3% (10.1–12.6) to 7.9% (6.4–8.8) (p = 0.045); and at spread site 3 from 16.2% (14.9–17.4) to 11.7% (10.3–13.0) (p < 0.001). 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. Conclusions: EQUIPPED was successfully implemented under both implementation models at four new sites during the COVID-19 pandemic, indicating the feasibility of adapting EQUIPPED to complex, real-world conditions. The hub-and-spoke model offers an effective way to scale-up EQUIPPED though a speed or quality advantage could not be shown.

Original languageEnglish
JournalJournal of the American Geriatrics Society
StateAccepted/In press - 2024


  • academic detailing
  • emergency medicine
  • health services research
  • patient safety
  • potentially inappropriate medication list


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