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Generating Evidence on Deprescribing Safety

Award Number: R01AG070047
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 03/15/2021
PERIOD OF PERFORMANCE END DATE: 08/31/2025

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Generating Evidence on Deprescribing Safety - PROJECT SUMMARY: GEODES R01 AG070047-01 Older adults with multiple chronic conditions (MCC), especially those with Alzheimer’s Disease and Related Dementias (ADRD), have an increased risk of polypharmacy, adverse drug events, treatment burden, and cognitive changes from medication side effects. Deprescribing is the process of reducing or stopping inappropriate medications or medications unlikely to be beneficial supervised by a health-care professional. Patients, caregivers for people with ADRD, and clinicians list potential adverse drug withdrawal events (ADWE) following medication discontinuation as a key barrier to deprescribing. ADWE are not well reported by deprescribing trials, and no large-scale interventions have reported prevalence or predictors of ADWE. Further, ADWE presenting in ambulatory care are rarely captured. This lack of evidence is largely due to inadequate methods for measuring ADWE: Identifying and measuring ADWE requires knowing the timing of medication discontinuation and understanding whether subsequent symptoms or diagnoses constitute ADWE. Our experience with safety monitoring for the OPTMIZE intervention of deprescribing education in ADRD (R33AG057289, MPIs Bayliss / Boyd), a pragmatic, cluster randomized trial to increase deprescribing awareness among patients with ADRD, their family, and primary care clinicians, has exemplified these methodologic gaps and provided the impetus for the proposed work. The project will leverage knowledge and methods from safety monitoring for the ADRD population in OPTIMIZE, combined with rich longitudinal clinical and pharmacy data from the Kaiser Permanente Colorado (KPCO) EHR and Virtual Data Warehouse (VDW) to develop and test methods to generate robust evidence on deprescribing safety. Our study populations will be older adults with MCC and the OPTIMIZE population with dementia plus MCC. Aim 1 will identify individuals who experience medication discontinuation and subsequent ADWE using record review and adjudication. Aim 2 will develop and validate a text mining tool to identify medication discontinuation applicable to multiple classes of medications. Aim 3 will apply the text mining tool in combination with common ADWE diagnoses in two separate cohorts to demonstrate a data-based approach to identifying medication discontinuation and possible ADWE: a sample of older adults with MCC and the OPTIMIZE population of individuals with dementia plus MCC. Aim 4 will model patient and clinical factors predictive of ADWE in the ADRD and MCC populations. Generating adequate evidence to support safe and effective deprescribing for ADRD and MCC populations requires new data-based methods and approaches.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Aging Research	000	2	1/24/2025	EXTENSION WITH OR WITHOUT FUNDS	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $742,760 )
2024	2024	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Aging Research	000	2	4/26/2024	EXTENSION WITH OR WITHOUT FUNDS	$541,565
2024	2024	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Aging Research	001	2	8/9/2024	EXTENSION WITH OR WITHOUT FUNDS	$201,195
														Subtotal = $742,760

Grand Total All Awards = $742,760

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Generating Evidence on Deprescribing Safety

Award Number: R01AG070047

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 03/15/2021

PERIOD OF PERFORMANCE END DATE: 08/31/2025

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