Modifying Default Dosing During Electronic Prescribing to Impact Prescribing of High-risk Drugs in Hospitalized Elderly Patients: A Cluster Randomized Controlled Trial With Crossover
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 8,640
- 试验地点
- 2
- 主要终点
- Prescription rate of modified default dose for eight high-risk drugs
研究概览
简要总结
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
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Health Services Research
- 盲法
- Double (Participant, Care Provider)
盲法说明
Participants and care providers will be unaware of the intervention. However, prescribers will be able to prescribe all available doses, without any restrictions
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •a patient must be hospitalized
- •65-years old or older
- •receive one of the targeted medications
排除标准
- 未提供
研究组 & 干预措施
Control
No change in default dose or frequency selected for the eight targeted drugs
Intervention
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.
干预措施: EHR-based "nudge" interventions (Behavioral)
结局指标
主要结局
Prescription rate of modified default dose for eight high-risk drugs
时间窗: 24 weeks
Rate at which the modified default dose (geriatric standard) and frequency for eight high-risk drugs are prescribed.
次要结局
- Mean per-patient dose(24 weeks)
- Rate of 30-day readmissions(30 days post-discharge regarding hospitalization during which a high-risk drug was prescribed)
- Length of hospital stay(24 weeks)
- Cost of hospital stay(24 weeks)
- Spillover effects to patients aged <65(24 weeks)
- Drug-specific prescription rate(24 weeks)
- Rate of inpatient falls(24 weeks)
研究者
Jashvant Poeran
Associate Professor Depts. of Population Health Science & Policy / Orthopedics / Medicine Director, Center for Clinical and Outcomes Research
Icahn School of Medicine at Mount Sinai