N/A N=24 Randomized Health Services Research

MIDAS Cluster Randomized Controlled Trial of Implementation Strategies to Optimize Use of Medications in VA Clinical Settings

Polypharmacy · Insomnia · Anticoagulants

Bottom Line

View on ClinicalTrials.gov: NCT05065502 ↗

Enrolled (actual)

Serious AEs

—

Results posted

Oct 2025

Primary outcome: Primary: Change in the Percentage of Patients With Potentially Inappropriate Medication Use (PIMs) Between Pre- and Post-periods, Across Facilities. — -0.133; -0.395 percentage of patients with PIMs — p=0.273

Study Design & Population

Study type: Interventional
Phase: N/A
Interventions: Academic Detailing (AD) (Behavioral); LEAP (Behavioral)
Age: Pediatric, Adult, Older Adult
Sex: All
Sponsor: VA Office of Research and Development
Primary completion: Mar 2024

Outcome Measures

Outcome	Result	p-value
PRIMARY Change in the Percentage of Patients With Potentially Inappropriate Medication Use (PIMs) Between Pre- and Post-periods, Across Facilities.	-0.133; -0.395	0.273
SECONDARY Change in Patients With Percentage of Potentially Inappropriate Use of Medications (PIMs) Across Facilities	-0.01756; -0.01618	—
SECONDARY Change in Monthly Medication Costs for All Drugs Across Facilities	70.73; 13.72	—
SECONDARY Change in Number of Medication Reviews Across Facilities	-0.00004; -0.00064	—
SECONDARY Change in Number of Inappropriate Medications at a Patient-level	-0.00625; -0.05942	—
SECONDARY Change in Percentage of Patients With High-risk Direct Oral Anticoagulant (DOAC) Use Across Facilities	0.64; 0.53	—
SECONDARY Change in Percentage of Patients With Direct Oral Anticoagulant (DOAC) Flags Attributable to Chronic Kidney Disease Across Facilities	0.31; 0.11	—
SECONDARY Change in Percentage of Patients With Direct Oral Anticoagulant (DOAC) Flags Attributable to Weight Across Facilities	0.17; 0.49	—
SECONDARY Change in Percentage of Patients With Direct Oral Anticoagulant (DOAC) Flags Attributable to Other Mis-dosing Across Facilities	0.20; 0.02	—
SECONDARY Change in Percentage of Patient Receipt of Any Cognitive Behavioral Therapy for Insomnia (CBTI) Across Facilities	-0.00922; 0.00085	—
SECONDARY Change in Mean Cognitive Behavioral Therapy for Insomnia (CBTI) Sessions Completed	—	—
SECONDARY Change in the Monthly Percentage of Patients Referred to Cognitive Behavioral Therapy for Insomnia (CBTI) Across Facilities	—	—
SECONDARY Change in Percentage of Patients With First Line Sleep Medication Across Facilities	0.02206; -0.06164	—

Summary

Scientific advances are constantly leading to better treatments. However, it is quite challenging for healthcare systems, including VA, to ask very busy providers to change the way they practice. The MIDAS QUERI program will help providers improve the way they treat VA patients for three common conditions, using specific strategies to ensure the reliable delivery of these treatments. The first project will focus on reducing potentially inappropriate medication (PIM) use using the VIONE practice, developed in VA. The second project will focus on better use of drugs called direct oral anticoagulants (DOACs) for patients with a history of severe blood clots or an abnormal heart rhythm. The third project will focus on increasing the use of cognitive behavioral therapy for insomnia as the first-line treatment for insomnia instead of sleep medications. The investigators will test two implementation approaches to improve medication use within these topics.

Eligibility Criteria

Inclusion Criteria

Note- the investigators are recruiting clinics - not individual patients.

Prior to implementation, the investigators will work with sites to ensure they have met the preconditions necessary to begin sustained optimization of the EBP:
a team leader or champion
an identified department with service leadership buy-in and control over the processes/practices impacted by the implementation
readily accessible data to measure process and impact of the implementation and use of the EBP
availability of required resources

Exclusion Criteria

N/A

View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT05065502). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.