Preliminary Implementation of an Informational Nudge to Improve Heart Failure Prescribing
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 81
- 试验地点
- 1
- 主要终点
- Effectiveness (MRA Prescriptions)
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Health Services Research
- 盲法
- Single (Investigator)
盲法说明
Statistician will be blinded to treatment assignment.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Primary care and cardiology clinicians at Southern AZ VA Health Care System working in outpatient clinic setting
排除标准
- •Clinicians who are in training status (resident, fellow) will be excluded.
研究组 & 干预措施
Alert and Peer Comparison
The combined alert and peer comparison arm will receive both interventions.
干预措施: Alert (Behavioral)
Control
No alert or peer comparison
Peer Comparison Report
Clinicians assigned to peer comparison, will receive messages by secure email every two weeks regarding their SGLT2i and MRA prescribing performance.
干预措施: Peer comparison report (Behavioral)
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.
干预措施: Alert (Behavioral)
Alert and Peer Comparison
The combined alert and peer comparison arm will receive both interventions.
干预措施: Peer comparison report (Behavioral)
结局指标
主要结局
Effectiveness (MRA Prescriptions)
时间窗: 30 days
The primary effectiveness outcome is the amount 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). Data represent a cumulative number of prescriptions filled.
Effectiveness (SGLT2 Prescriptions)
时间窗: 30 days
The primary effectiveness outcome is the amount 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). Data represent a cumulative number of prescriptions filled.
次要结局
- Implementation-Feasibility(6 months)
- Reach-Clinician(6 months)
- Incidence of Treatment Emergent Adverse Events(30 days)
- Implementation-Acceptability(6 months)
- Reach-Patient(6 months)
- Reach-Comparison of Strategies(6 months)
- Implementation-Appropriateness(6 months)