Introduction: The Vital, Important, Optional, Not indicated, and Every medication has an indication (VIONE) methodology is a medication optimization and deprescribing intervention created by the VA in 2016 for older adults. Patients’ experiences after the deprescribing interventions have not been explored within the VA or other health systems. Given the gap in knowledge and the VA system’s wide use of VIONE, there is a need to develop a process that explores the association between patients’ experiences with the deprescribing intervention and how it translates to improved health and medication outcomes. This study aims to refine and validate a Deprescribing Evaluation and Quality Improvement (DEQI) instrument using the Delphi technique.

Methods: Content analysis of 17 interviews with Veterans aged =65, who had VIONE deprescribing experiences was used to generate constructs and items for the DEQI instrument. Following this, deprescribing experts composed of Physicians and Pharmacists (N=21) were selected and invited to join a Delphi panel. The Delphi technique was used in two rounds of a Qualtrics survey to obtain responses from experts. In the first round, experts assessed the relevance of 37 constructs and dimensions (C&D). In the second round, experts rated 75 items for relevance and clarity. The criterion for establishing retention in the first round was a 50% consensus that the construct or dimension is very relevant. An item content validity index (I-CVI) of =0.70 in the second round was applied for relevance.

Results: The response rate of the experts was 95% in rounds 1 and 2. A total of 7 C&D (19%) were eliminated after round 1. Nineteen items (25%) with I-CVI =0.70 for relevance were eliminated after round 2. Duplicates (2 items) were dropped. Items were modified based on I- CVI =0.70 for clarity (26 items) and feedback comments from the experts (38 items). Four other items were coalesced into two. One item was split into two and five new items were added based on feedback. The 75-item survey was reduced to 52 items, with six new items added resulting in 58 final items.

Conclusion: Developing an instrument to evaluate and improve the quality of deprescribing interventions requires the involvement of researchers and professionals who would utilize the data to improve health outcomes. Experts achieved consensus and validated the DEQI instrument’s content. The draft instrument will be refined through cognitive interviews and pilot-tested.