SUPPORTED BY A GRANT FROM THE MOTHER CABRINI HEALTH FOUNDATION
Polypharmacy refers to the overprescribing of potentially inappropriate medications. With support from the Mother Cabrini Health Foundation and TD Bank Charitable Foundation, United Hospital Fund has been leading initiatives to address the problem of polypharmacy among older adults in the nursing home.
Why This Is Important
While there is no clear definition of polypharmacy based on a particular number of prescribed medications, polypharmacy refers to the overprescribing of potentially inappropriate medications, some of which may be harmful. Crucially for nursing homes, frail elders are even more susceptible to the harms of polypharmacy than the general population, and poor outcomes–such as adverse drug events, falls with injury, hip fractures, cognitive impairment, and hospitalizations–are not uncommon. However, there is growing evidence of the effectiveness of “deprescribing” practices, which decrease the use of inappropriate medications and ultimately reduce the burden and risks polypharmacy.
Our Work
To see our reports summarizing our previous work and findings from both years of our learning collaborative to address polypharmacy in the nursing home, click on the links below.
UHF recently completed the second year of the learning collaborative with seven nursing homes in the New York City area. Participants designed and implemented quality improvement interventions to address polypharmacy in their long-term care residents. We expanded our list of target medications and have strongly infused our curriculum with the principles of the Institute for Healthcare Improvement’s (IHI) Age-Friendly Health Systems Framework.
With the support of clinical faculty and UHF staff, the nursing homes participated in structured learning sessions, received coaching to develop and implement their interventions, chose medication categories most relevant to their resident population, and collected data to assess the impact of their interventions.
In the final report you can find the learning collaboratives findings, details on the nursing homes’ interventions, and recommendations for other organizations wishing to develop their own deprescribing initiatives.
STOPPFrail
Beginning in 2024, United Hospital Fund is continuing its work to address polypharmacy in older adults with a new initiative supported by the TD Bank Charitable Foundation with a specific focus on residents with severe frailty and who are nearing the end of life. An evidence-based tool has been developed in recent years to assist this – the STOPPFrail criteria – which supports providers to identify frail patients and then deprescribe drugs which are particularly dangerous to this population. Using a learning collaborative approach, nursing home participants will test using the tool in their facilities to identify frail residents and attempt to decrease the number of inappropriate medications that are currently prescribed. A report sharing the findings and lessons learned will be published following the initiative.
Joan leads UHF’s Quality Institute team and initiatives, focused on building quality capacity in health care organizations, engaging patients and families in care, and profiling quality. She directs the Clinical Quality Fellowship Program in partnership with Greater New York Hospital Association and develops and leads projects and learning collaboratives focused on implementing best practices and improving delivery of care.
Before joining UHF in 2017, Joan was director of quality improvement for Robert Wood Johnson University Hospital Somerset, a 300-bed community hospital in New Jersey. There she managed the quality services department and was responsible for Joint Commission accreditation, CMS/TJC quality reporting, hospital performance improvement initiatives, the medical peer review process, and reporting of serious adverse events and the root cause analysis process. Earlier in her career she was director of standards for St. Barnabas Medical Center, also in New Jersey, and director of Accreditation and Standards Compliance and director of Program Development and Planning for NYU Langone Medical Center.
Joan holds a Master of Business Administration in Health Care Management from Boston University and a Bachelor of Science in Occupational Therapy from Tufts University. She is a Certified Professional in Health Quality and a Lean Six Sigma Green Belt.
Alice joined UHF in late 2021 as Senior Program Manager in the Quality Institute. She is involved in all aspects of the Institute’s quality improvement efforts, including program design, implementation, and evaluation; project management and reporting; and research and data analysis. She also supports UHF’s Quality Leaders Forum.
Alice came to UHF from Healthfirst, a provider of low and no-cost health insurance in New York State, where she was Population Health Manager, responsible for ensuring that Healthfirst achieved a high rating in the Medicare Stars quality incentive program administered by the Centers for Medicare & Medicaid Services. Prior to Healthfirst, Alice was a Public Health Strategist in the local government of two inner-London boroughs, Camden and Islington. There she partnered with the British National Health Service to design and implement public health improvement initiatives, such as the introduction of the National Diabetes Prevention Program, into all Primary Care practices across the boroughs.
Alice holds a Master of Science in Public Health from the London School of Hygiene and Tropical Medicine and a Bachelor of Science from the University of Manchester, both in the United Kingdom