Modifying Default Dosing During Electronic Prescribing to Impact Prescribing of High-risk Drugs in Hospitalized Elderly Patients: A Cluster Randomized Controlled Trial With Crossover
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 8,640
- Locations
- 2
- Primary Endpoint
- Prescription rate of modified default dose for eight high-risk drugs
Study Overview
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
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Crossover
- Primary Purpose
- Health Services Research
- Masking
- Double (Participant, Care Provider)
Masking Description
Participants and care providers will be unaware of the intervention. However, prescribers will be able to prescribe all available doses, without any restrictions
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •a patient must be hospitalized
- •65-years old or older
- •receive one of the targeted medications
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Prescription rate of modified default dose for eight high-risk drugs
Time Frame: 24 weeks
Rate at which the modified default dose (geriatric standard) and frequency for eight high-risk drugs are prescribed.
Secondary Outcomes
- Drug-specific prescription rate(24 weeks)
- 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)
- Rate of inpatient falls(24 weeks)
Investigators
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