UHF Initiative Tackling Medication Overload in Nursing Homes Kicks Off Second Year

After a successful first year, a United Hospital Fund project aimed at helping older adults is expanding its reach in 2023.  

The Polypharmacy Learning Collaborative, which received renewed support from the Mother Cabrini Health Foundation this year, held its first learning session of 2023 in March. As it did in 2022, the project will help nursing homes reduce polypharmacy, or the prescribing of an inappropriately high number of medications that may increase adverse outcomes like drug-drug interactions, falls, cognitive impairment, and hospitalization. 

The second year of the project will expand the list of high-risk medications targeted for deprescribing and dose reduction and will add two newly recruited nursing facilities to those participating in the year-long intervention.  

The project will also integrate an innovative framework known as Age-Friendly Health Systems. The Age-Friendly model is a set of evidence-based principles aimed at improving patient-centered care for older adults. The Healthcare Association of New York State (HANYS) has been leading an Age Friendly Action Community in New York State since 2020 and is partnering with UHF in this year’s initiative. 

“This really is the future of care for older adults in all health systems,” Dora Fisher, director of post-acute and continuing care at HANYS, told learning session participants. “UHF and HANYS are working together to put this deprescribing work within that greater context...We want to align this kind of work within the context of Age-Friendly to help it sustain long-term.” 

Developed by The John A. Hartford Foundation and the Institute for Healthcare Improvement, Age-Friendly organizes care around a set of elements known as the “4Ms”: What Matters, Medication, Mentation, and Mobility. The principles, used by more than 3,000 facilities across the nation, have been shown to improve patient experience scores, as well as quality outcomes such as readmissions, emergency department utilization, and length of stay. 

Age Friendly Health Systems organizes care around the "4Ms."
Age Friendly Health Systems organizes care around the "4Ms."

In the polypharmacy learning session, nursing facility staff participated in a group exercise aimed at evaluating their own use of the “4Ms” and brainstorming ways they could better incorporate the principles in medication management practices. 

The participants also learned about prescribing issues for high-risk medication types and will focus on tackling two to three of them as part of their participation in the collaborative. The medications were selected by UHF in collaboration with the project’s clinical faculty, who drew on Age-Friendly guidelines and published literature. 

The nursing facilities will spend the next few months creating a plan for their interventions with the support of UHF staff and clinical faculty. The interventions, set to begin in May, will focus on medication categories most relevant to the facility’s resident population and will include collecting data to assess their impact and longer-term outcomes. 

In its first year, nursing facilities participating in UHF’s Polypharmacy Learning Collaborative observed a 16 percent decrease in the proportion of residents prescribed 10 or more medications. UHF will soon publish its 2022 findings, together with tools and recommendations for other organizations wishing to develop their own deprescribing initiatives.