Evaluating the Efficacy of Different Electronic Medical Record Alerts to Increase Pediatric Lipid Screening Across a Large Integrated Health System
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 13,340
- 试验地点
- 1
- 主要终点
- Lipid Panel Order
研究概览
简要总结
The purpose of the study is to evaluate prospectively the impact of different system alerts on the prescription of lipid panels to pediatric Geisinger patients (9-11 years old), as per the now-universal guidelines. This will help quantify the relative effectiveness of different alerts and combinations of alerts on provider prescribing behavior and patient uptake of screening.
详细描述
Patients who are eligible for this study will be randomized into one of four groups via an Epic electronic medical record (EMR) randomization algorithm run automatically at the time of the visit:
- Control group (6-month delay before their providers will receive an alert)
- Health maintenance topic (HMT)
- Best practice alert (BPA)
- Best practice alert and health maintenance topic (BPA+HMT)
Geisinger Health System will introduce Epic's Storyboard panel (a novel way of summarizing patient information in the EMR) approximately one month into this study. The analysis plan will therefore test for the potential impact of this change.
The providers will be prompted to discuss and order screening lipid study that is non fasting at the time of the visit with the patient, based on the alerts above. Some families will have an alert in their MyGeisinger portal stating that a health maintenance test is due and to discuss with their provider.
Outcomes will be reviewed and classified as followed,
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Screening
- 盲法
- Double (Participant, Care Provider)
入排标准
- 年龄范围
- 9 Years 至 11 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •male or female patients between the ages of 9 - 11
- •seen within a primary care, cardiology, endocrinology, urgent care (CareWorks), or nutrition clinic at Geisinger
排除标准
- •patients who have completed a lipid screen in the EMR
- •patients who were determined to have familial hypercholesterolemia based on prior screening
研究组 & 干预措施
Passive Control
Will consist of no alerts and will serve to examine lipid panel screening rates given the current standard of care. After 6 months, providers in this (and other conditions) will receive the alert(s) with the best demonstrated success in increasing screening rates.
Best Practice Alert (BPA-only)
Will consist of a BPA that fires for providers during a visit with an eligible 9-11 year-old patient. This is an active opt-in alert wherein the provider must respond, either confirming the prescription of a lipid panel or opting out with an acknowledgment/reason for declining the test. The BPA will include a recommendation to administer the screen in combination with existing scheduled bloodwork.
干预措施: Best Practice Alert (Behavioral)
Health Maintenance Topic (HMT-only)
Will consist of an HMT in Epic that is present for providers at their visit with an eligible patient. The HMT will be highlighted for enhanced visibility, until or unless action is taken.
干预措施: Health Maintenance Topic (Behavioral)
BPA+HMT
Will consist of both the BPA and HMT presented simultaneously in Epic.
干预措施: Best Practice Alert (Behavioral)
BPA+HMT
Will consist of both the BPA and HMT presented simultaneously in Epic.
干预措施: Health Maintenance Topic (Behavioral)
结局指标
主要结局
Lipid Panel Order
时间窗: 1 day
Provider ordered a lipid panel to an eligible patient during the patient's first visit within the study period (binary variable).
Lipid Panel Screening
时间窗: 1 week
Patient completed a lipid panel screening within seven days of the patient's first visit (binary variable). This screening is not linked to any order made at the patient's first visit (i.e., Outcome Measure 1).
次要结局
未报告次要终点
研究者
Amir Goren
Program Director, Behavioral Insights Team
Geisinger Clinic