Deprescribing research in nursing home residents using routinely collected healthcare data: a conceptual framework

Thorpe, Carolyn; Niznik, Joshua; Li, Anna

doi:10.1186/s12877-023-04194-5

Table 1 Social-ecological levels and domains included in observational studies of deprescribing in nursing home residents

From: Deprescribing research in nursing home residents using routinely collected healthcare data: a conceptual framework

Author (year)	Sample	Setting	Data Sources	Target Medications	Social-Ecological Levels Included	Domains
Onder et al. (2019) [32]	1,843 newly admitted NH residents taking ≥ 5 medications at baseline who remained in the NH for at least 6 months	57 NHs in 7 European Union countries and Israel	MDS and EHR data from 2009–11	Any medication: Total medications used	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis • Co-prescribed medications
Onder et al. (2019) [32]		57 NHs in 7 European Union countries and Israel	MDS and EHR data from 2009–11	Any medication: Total medications used	Interpersonal	• Healthcare provider factors
Vu et al. (2021) [23]	10,574 newly admitted NH residents with LLE/AD who were potentially overtreated for hypertension	VA NHs in the U.S	MDS and EHR data from 2009–15	Antihypertensive medications	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Organizational	• Facility resources • Care coordination
					Community	• Geographic factors
					Policy	• Time trends
Paque et al. (2019) [34] EJCP	296 NH residents with end stage organ failure, advanced cancer, and/or dementia	10 NHs in Flanders, Belgium	Chart reviews, structured interviews	Any medication: chronic medications potentially suitable for deprescribing (PIMs)	Intrapersonal	• Sociodemographics • Prognosis
Paque et al. (2019) [34] EJCP		10 NHs in Flanders, Belgium	Chart reviews, structured interviews		Interpersonal	• Family caregiver factors
Mack et al. (2020) [30]	73,247 newly admitted NH residents receiving statins	13,092 Medicare- and Medicaid-certified non-SNF NHs	MDS and EHR data	Statins	Intrapersonal	• Sociodemographics • Index condition attributes • Prognosis • Co-prescribed medications
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Organizational	• Facility resources • Care coordination
					Community	• Geographic factors
Paque et al. (2019) [33] BJCP	74,368 > 75 years of age who died in 2012	Belgium	7 healthcare insurers in Belgium and the Belgian Cancer Registry claims	PIMs: medications for long‐term prevention, medications for which chronic use is inappropriate, and (outdated) medications for which a safer alternative exists	Intrapersonal	• Sociodemographics • Prognosis • Co-prescribed medications
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Organizational	• Care coordination
					Community	• Geographic factors
Maclagan et al. (2018) [31]	47,851 newly admitted NH residents with dementia	NHs in Ontario, Canada from 2011–15	MDS and EHR data	Cholinesterase inhibitors	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis • Co-prescribed medications
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Organizational	• Care coordination
					Community	• Geographic factors
Hamada et al. (2021) [29]	1,201 Roken (type of LTCF) residents with dementia	343 Roken in Japan	Mailed drug utilization questionnaires to medical directors/facility managers	Psychotropic and anticholinergic drugs	Intrapersonal	• Sociodemographics • Index condition attributes • Prognosis • Co-prescribed medications
Niznik et al. (2019) [25]	37,106 NH residents with severe dementia receiving AChEIs	Non-SNF NHs in the U.S	MDS and EHR data	Anticholinesterase inhibitors	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis • Co-prescribed medications
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Organizational	• Facility resources • Care coordination
					Community	• Geographic factors
Niznik et al. (2020) [13, 15, 17]	6,960 veterans admitted to NHs with diabetes and LLE/AD	VA NHs in the U.S. from 2009–15	MDS and EHR data	Diabetes medications	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis • Co-prescribed medications
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Policy	• Reporting (time trends)
Niznik et al. (2022) [26]	5,312 NH residents with dementia and prescription for oral bisphosphonates	Non-SNF NHs in the U.S	MDS and EHR data	Bisphosphonates	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis • Co-prescribed medications
					Interpersonal	• Healthcare provider factors
					Organizational	• Facility resources • Care coordination
					Community	• Geographic factors
Odden et al. (2021) [28]	31,499 LTC residents admitted to NH receiving antihypertensive medications	VA NHs in the U.S. from 2006–2019	MDS and EHR data	Antihypertensive medications	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis
Odden et al. (2021) [28]		VA NHs in the U.S. from 2006–2019	MDS and EHR data	Antihypertensive medications	Policy	• Reporting (time trends)
Song et al. (2018) [14]	2,212 NH residents who were potentially overtreated for hypertension	132 VA NHs in the U.S. from 2010–2015	MDS and EHR data	Antihypertensive medications	Intrapersonal	• Sociodemographics • Index condition attributes • Index medication attributes • Prognosis • Co-prescribed medications
Springer et al. (2020) [24]	13,844 newly admitted NH residents with history of CAD or stroke/TIA receiving aspirin	VA NHs in the U.S. from 2009–2015	MDS and EHR data	Aspirin	Intrapersonal	• Sociodemographics • Index condition attributes • Prognosis • Co-prescribed medications
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Organizational	• Care coordination • Facility resources
					Community	• Geographic factors
					Policy	• Time trends
Thorpe et al. (2020) [16]	13,110 newly admitted NH residents with LLE/AD receiving statins	VA NHs in the U.S. from 2009–2015	MDS and EHR data	Statins	Intrapersonal	• Sociodemographics • Index condition attributes • Prognosis • Co-prescribed medications
					Interpersonal	• Family caregiver factors • Healthcare provider factors
					Organizational	• Facility resources • Care coordination
					Community	• Geographic factors
					Policy	• Time trends

NH nursing home, VA Veteran Affairs, MDS Minimum Data Set, EHR electronic health records, LLE/AD limited life expectancy/advanced dementia, PIM potentially inappropriate medications, SNF skilled nursing facility, LTC long-term care, LTCF long-term care facility, AChEIs acetylcholinesterase inhibitors, U.S United States, CAD coronary artery disease, TIA transient ischemic attack

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