Informational Nudge to Improve Heart Failure Prescribing
- Conditions
- Heart Failure
- Interventions
- Behavioral: AlertBehavioral: Peer comparison report
- Registration Number
- NCT05986695
- Lead Sponsor
- VA Office of Research and Development
- Brief Summary
This study addresses a critical gap of care for Veterans with heart failure (HF). Only 1/3 or fewer eligible Veterans are receiving recommended SGLT2 and MRA therapies that save lives and prevents HF hospitalizations. The investigators will compare the effect of clinician directed nudges as strategies to improve the health of Veterans with HF.
- Detailed Description
This study addresses a critical gap in quality of care for Veterans with heart failure (HF). Only 1/3 or fewer eligible Veterans are receiving SGLT2 inhibitors and mineralocorticoid receptor antagonists, both medications that save lives and prevents HF hospitalizations. The investigators will combine insights from behavioral science and quality improvement science to create two types of 'nudges' - informational alerts and peer comparison feedback - to increase prescribing of these medications. The investigators will create two types of 'nudges' - informational alerts and peer comparison feedback - to increase prescribing of these medications. The investigators will compare the effect of these two nudge strategies alone and in combination compared to usual care. This project will develop simple, scalable, and low-cost strategies to improve the health of Veterans with HF.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 89
- Primary care and cardiology clinicians at Southern AZ VA Health Care System working in outpatient clinic setting
- Clinicians who are in training status (resident, fellow) will be excluded.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Alert and Peer Comparison Peer comparison report The combined alert and peer comparison arm will receive both interventions. Peer Comparison Report Peer comparison report Clinicians assigned to peer comparison, will receive messages by secure email every two weeks regarding their SGLT2i and MRA prescribing performance. Alert Alert Clinicians in the alert arm will receive an alert two business days prior to a patient's upcoming appointment. Clinicians will receive approximately two alerts per week. Alert and Peer Comparison Alert The combined alert and peer comparison arm will receive both interventions.
- Primary Outcome Measures
Name Time Method Effectiveness 30 days The primary effectiveness outcome is the proportion of SGLT2 or MRA prescriptions in eligible HF patients in the three intervention groups compared with the control group within 30 days of appointment. Thirty days is a common time interval for HF outcomes assessment and allows for chart documentation, care coordination, laboratory testing, and medication prescribing that may occur days after a patient encounter. The investigators will record all SGLT2 or MRA prescriptions, including those from non-targeted clinicians, given that nudge interventions, especially the informational alert, may impact other clinicians directly (e.g., view alert in EHR) or indirectly (e.g., referral from targeted clinician).
- Secondary Outcome Measures
Name Time Method Reach-Clinician 6 months Reach will be measured at the clinician level as the number of unique clinicians who received an informational alert or peer comparison.
Implementation-Acceptability 6 months Implementation will be assessed by clinician-directed survey of Acceptability of intervention Measure. Likert Scale: minimum 1 and maximum 5. 5 being the highest.
Implementation-Feasibility 6 months Implementation will be assessed by clinician direct survey of Feasibility of Intervention Measure. Likert scale: minimum 1 and maximum 5. 5 being the highest.
Incidence of Treatment Emergent Adverse Events 30 days The investigators will measure safety as the number of discontinued prescribed medicine due to suspected adverse effects within 30 days of the nudge interventions.
Reach-Comparison of Strategies 6 months the investigators will measure the proportion of alerts relative to the total number of eligible patients with HF; this denominator will allow for comparisons of representativeness of the alert strategy.
Reach-Patient 6 months At the patient level, Reach will be measured as the number of informational alerts delivered for unique patient visits and unique patients.
Implementation-Appropriateness 6 months Implementation will be assessed by clinician direct survey of Intervention Appropriateness Measure. Likert scale: minimum 1 and maximum 5. 5 being the highest.
Trial Locations
- Locations (1)
Southern Arizona VA Health Care System, Tucson, AZ
🇺🇸Tucson, Arizona, United States