New Solutions to Support Evidence-based Prescribing for Heart Failure
Trial Snapshot
- Phase
- Not Applicable
- Status
- Active, not recruiting
- Enrollment
- 764
- Locations
- 2
- Primary Endpoint
- Number of CDS alerts resulting in the prescription of a recommended medication
Study Overview
Brief Summary
Clinical decision support (CDS) tools can 'nudge' clinicians to make the best decisions easy. Although required by "meaningful use" regulations, more than 40% of CDS lead to no change and the remaining lead to improvements that are modest at best. This is because CDS tools often ignore contextual factors and present irrelevant information. Although many tools have undergone patient-specific optimization, 'traditional CDS' are rarely clinician-specific. For example, a traditional CDS tool for beta blockers and heart failure with reduced ejection fraction (HFrEF) addresses common prescribing misconceptions by stating asthma is not a contraindication and providing a safe threshold for blood pressure. For clinicians without these misconceptions, these statements are irrelevant and distract from key information. A 'personalized CDS' would evaluate clinician past prescribing patterns to determine whether prescribing misconceptions might exist and then conditionally present information to address those misconceptions. The objective of this research is to create personalized clinician-specific CDS that overcome shortcomings of traditional CDS. The central hypothesis is a personalized CDS that minimizes irrelevant information will lead to a higher rate of prescribing guideline-directed management and therapy (GDMT) for HFrEF compared to a traditional CDS.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 89 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •The study subjects are potential users of the CDS, specifically clinicians with prescribing privileges who practice at one of the health system's (UCHealth) outpatient cardiology or primary care clinics. Because we are observing their prescribing behaviors, we are also evaluating patient characteristics which could influence their prescribing decisions.
Exclusion Criteria
- •Clinicians who do not practice in cardiology or primary care clinics or do not practice within UCHealth system.
Arms & Interventions
Traditional Clinical Decision Support (CDS)
Clinicians will receive traditional CDS and perform usual care, which is patient-specific but not clinician-specific.
Intervention: Traditional Clinical Decision Support (CDS) (Other)
Personalized Clinical Decision Support (CDS)
Clinicians will receive a personalized CDS intervention that evaluates clinician past prescribing patterns to determine whether prescribing misconceptions might exist, and then conditionally present information to address those misconceptions through a nudge in the EHR.
Intervention: Personalized Clinical Decision Support (CDS) (Other)
Outcomes
Primary Outcomes
Number of CDS alerts resulting in the prescription of a recommended medication
Time Frame: 6 months
The primary outcome is number of CDS alerts that resulted in the prescription of the medication recommended by the CDS alert. Recommended medications include either evidence-based beta blockers, sacubitril/valsartan, mineralocorticoid receptor antagonists or sodium/glucose cotransport 2 inhibitors. Prescriptions will be based on actual prescription orders instead of clinician-stated responses, given the latter may overestimate effectiveness.
Secondary Outcomes
- Number of patients the CDS alerted for(6 months)
- Number of prescription orders for guideline directed management and therapies (GDMT) for heart failure(6 months)
- Number of alerts that were not outright dismissed(6 months)