Table 2 Conceptual framework domains, constructs, and example variables
Framework level | Domain | Constructs | Examples of variables as operationalized in reviewed studies |
|---|---|---|---|
Intrapersonal | Patient Sociodemographic Characteristics | Age | - Age |
Sex or gender | Sex or gender | ||
Race/ethnicity | Race/ethnicity | ||
Socioeconomic status | - Income | ||
- Education level | |||
- Medicaid eligibility | |||
Index1 condition attributes | Severity or complexity | - Diabetic eye disease (hypoglycemic agents) | |
- Cardiovascular risk factors (aspirin, antihypertensives) | |||
- Congestive heart failure (antihypertensives) | |||
- Renal failure (antihypertensives) | |||
Current treatment or treatment target | - Baseline HbA1c control (hypoglycemic agents) | ||
- Baseline blood pressure (antihypertensives) | |||
- Aggressive behavior (AChEIs) | |||
- Duration of treatment (bisphosphonates) | |||
Predisposition for medication-induced adverse events | - History of hypoglycemic events (hypoglycemic agents) | ||
- History of falls (antihypertensives, hypoglycemic agents) | |||
Index medication attributes | Adverse event risk of the index medication | - Sulfonylureas and insulin (hypoglycemic agents) | |
- Alpha blockers (antihypertensives) | |||
Complexity or burden of medication administration | - Insulin use (hypoglycemic agents) | ||
- Non-insulin injectables (hypoglycemic agents) | |||
- Oral versus transdermal formulation (AChEIs) | |||
- Special instructions for administration (bisphosphonates) | |||
Prognosis (i.e., life expectancy) | Overall comorbidity level | - Elixhauser comorbidities | |
- Charlson comorbidity index | |||
Frailty | - ADLs | ||
- Bedbound | |||
- Assistive mobility devices | |||
- Claims-based measures | |||
Failure to thrive | - Poor appetite | ||
- Recent weight loss | |||
- Dehydration | |||
- Infection | |||
- Renal failure | |||
Patient ability to take medications | - Swallowing difficulty (bisphosphonates) | ||
- Aggressive behavior (AChEIs) | |||
Co-prescribed medications | Other medications that modify the risks and benefits of treatment | - Total number of medications/polypharmacy | |
- Proton pump inhibitor use (aspirin) | |||
- Medications with metabolic adverse effects (hypoglycemic agents) | |||
Interpersonal | Family Caregiver Factors | Level of engagement in care and decision-making | - Patient marital status |
- Presence/absence of a next-of-kin/family caregiver | |||
- Relationship to patient (E.g., spouse, adult child, etc.) | |||
- Distance from caregiver residence to NH facility | |||
Healthcare Provider Factors | Provider predisposition to deprescribing | - Billing provider role (physician, NP, PA) or specialty | |
- Prescribing provider role or specialty | |||
- Admission source (community, hospital, other facility) | |||
- Treating specialty/bed type (e.g., hospice) | |||
Organizational and Health System | Health System Factors | Healthcare system and facility resources | - Facility type (e.g., CCRC) |
- Staffing hours | |||
- Turnover rates | |||
- Ownership (nonprofit vs. for profit) | |||
- Number of beds | |||
- Academic affiliation | |||
- Availability of specialty services (e.g., hospice, dementia care unit) | |||
Care coordination | Opportunities for fragmented healthcare delivery | - Care team composition | |
- External providers or specialists | |||
- Admission source | |||
Community | Regional/Geographic variation | Geographic patterns of healthcare use and deprescribing | - Region of country |
- Rural vs. urban | |||
Policy | Guidelines, Evidence, Reporting | Availability of guidelines, new evidence, or policies to facilitate deprescribing | - Time trends (year of admission) |