EVOLV-Rx VA: Evaluating Opportunities to Decrease Low-Value Prescribing in Community Living Centers

PI: Thomas Radomski, MD, MS
Funding Source: VA Merit
September 2025 - September 2029

The EVOLV-Rx VA study is a hybrid effectiveness-implementation project designed to reduce low-value prescribing among older Veterans who reside in Community Living Centers (VA Nursing Homes). Low-value prescribing—medications that provide little to no clinical benefit and may increase the risk of harm—is a widespread challenge in the care of older adults.

To address this, Dr. Tom Radomski and his team developed EVOLV-Rx, a novel clinical tool that identifies 18 evidence-based low-value prescribing practices. EVOLV-Rx was created and validated as part of Dr. Radomski’s NIH K23 Award, incorporating the expertise of clinicians as well as insights from patients and caregivers.

Building on this foundation, EVOLV-Rx VA will test an electronic dashboard that pharmacists can use during required medication reviews to provide deprescribing recommendations to clinicians. The study will be conducted in three phases: (1) working with Community Living Center partners to adapt the intervention and create an implementation playbook, (2) assessing the effectiveness of the intervention in reducing low-value prescribing, and (3) evaluating and refining implementation to ensure adoption and sustainability in practice.

By integrating evidence-based recommendations into routine care, this project aims to improve medication safety, reduce unnecessary prescribing, and enhance the quality of care for older Veterans.

Read published results from this work

VA Clinicians’ Perspectives on Low-Value Health Service Use in the Veterans Health Administration: A Qualitative Study
Zachary A. Cupler DC, MS, Kristina L. Hruska MS, Nicole M. Beyer MA, Loren J. Schleiden MS, Keri L. Rodriguez PhD, Liam Rose PhD, Aimee N. Pickering MD, MS, Carolyn T. Thorpe PhD, MPH, & Thomas R. Radomski MD, MS
Journal of General Internal Medicine, September 11, 2025