An Intuitive, Non-intrusive, Approach to Reduce Patient Harm From Inappropriate Dosing of High-risk Drugs in Older Adult Patients Across an Urban Safety Net Hospital System
- Conditions
- Potentially Inappropriate Medications
- Interventions
- Behavioral: EHR-based "nudge" interventions
- Registration Number
- NCT05218343
- Lead Sponsor
- Icahn School of Medicine at Mount Sinai
- Brief Summary
This study will assess whether a modification in the default dose and frequency (the first option a provider sees) during electronic prescribing of a high-risk drug can impact prescribing behavior and subsequent changes in average dose for the targeted high-risk drug, when prescribed to a hospitalized patient aged ≥65 years. In this cluster randomized crossover (CRXO) trial we will randomize a non-intrusive "nudge" intervention, which involves modifying the default dose for high-risk drugs when prescribed electronically to hospitalized patients aged ≥65 years. The CRXO trial involves 10 sites in an urban health system: five sites will start the trial under the intervention/control during a first time period (T1) after which they switch intervention/control status (T2). The primary outcome is prescription rate of a lower default dose (i.e. the geriatric standard) for 8 high-risk drugs. This study will inform the effectiveness of EHR-based "nudge" interventions to reduce inappropriate prescribing of high-risk drugs for elderly patients.
Analyses ongoing, expected to finalize spring 2023
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 8640
- a patient must be hospitalized
- 65-years old or older
- receive one of the targeted medications
- none
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Intervention EHR-based "nudge" interventions The first option a prescriber sees when prescribing any of eight high-risk drugs for elderly hospitalized patients will be modified; the first frequency option a prescriber sees will be modified as well. Providers retain the ability to prescribe any dose or frequency.
- Primary Outcome Measures
Name Time Method Prescription rate of modified default dose for eight high-risk drugs 24 weeks Rate at which the modified default dose (geriatric standard) and frequency for eight high-risk drugs are prescribed.
- Secondary Outcome Measures
Name Time Method Drug-specific prescription rate 24 weeks Drug-specific prescription rate of the modified default dose for each of the eight high-risk medications and type of order (frequency/type of order).
Mean per-patient dose 24 weeks Mean per-patient dose of the relevant individual high-risk drugs.
Rate of 30-day readmissions 30 days post-discharge regarding hospitalization during which a high-risk drug was prescribed 30-day readmission rates for patients aged ≥65 years who received any of the eight high-risk drugs during their hospitalization.
Length of hospital stay 24 weeks Duration of hospitalization in days for patients aged ≥65 years who received any of the eight high-risk drugs during their hospitalization.
Cost of hospital stay 24 weeks Cost of hospitalization in USD for patients aged ≥65 years who received any of the eight high-risk drugs during their hospitalization.
Spillover effects to patients aged <65 24 weeks The rate of prescriptions of the newly defaulted (geriatric) dose for any of the eight high-risk drugs among patients aged \<65 years.
Rate of inpatient falls 24 weeks Inpatient falls (with and without injury)
Trial Locations
- Locations (2)
Icahn School of Medicine at Mount Sinai
🇺🇸New York, New York, United States
NYC Health+Hospitals
🇺🇸New York, New York, United States