Nudging Provider Adoption of Clinical Decision Support

Not Applicable

Completed

• Conditions: Pulmonary Embolism
• Interventions: Other: Pulmonary Embolism Risk Kalculator (PERK)

• Registration Number: NCT05203185
• Lead Sponsor: NYU Langone Health

Brief Summary

The central hypothesis of this proposal is that the addition of a theory-informed "nudge" to a clinical decision support (CDS) tool will address identified behavioral barriers to use and significantly improve adoption by providers. Nudges are applications of behavioral science, defined as positive reinforcement and indirect suggestions that have a non-forced effect on decision making. This study will use a behavioral theory-informed process to develop a new CDS tool that includes a nudge that addresses barriers to adoption.

Detailed Description

The research team developed and pilot tested two CDS tools for pulmonary embolism (PE) risk stratification in the Emergency Department (ED). One of the tools incorporated two behavioral theory-informed nudges in the user interface. The research team's objective was to pilot test the tools to demonstrate feasibility as well as examine preliminary efficacy of the nudges on provider adoption of the tool. This cluster non-randomized controlled trial took place between September 20th, 2021 and March 3rd, 2022 in two EDs that are a part of a large academic health system in the New York City metropolitan area. All ED providers (physicians, physician assistants and nurse practitioners) seeing patients for the evaluation of PE during this time were included in the trial. The EDs were chosen based on their comparable size and acuity levels.

Study Timeline

• Study Start: 2021-07-01
• Study First Submitted: 2022-01-10
• Study First Submitted QC: 2022-01-10
• Study First Posted: 2022-01-24
• Primary Completion: 2022-04-30
• Study Completion: 2022-04-30
• Results First Submitted: 2023-05-03
• Status Verified: 2023-06
• Results First Submitted QC: 2023-06-01
• Last Update Submitted: 2023-06-01
• Results First Posted: 2023-06-26
• Last Update Posted: 2023-06-26

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1612

Inclusion Criteria

• Medical doctors, nurse practitioners and physician assistants working full time at Huntington Hospital and Long Island Jewish Valley Stream

Exclusion Criteria

• Does not meet the inclusion criteria

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention Site	Pulmonary Embolism Risk Kalculator (PERK)	Full time employed Emergency Department providers will use the new CDS tool, Pulmonary Embolism Risk Kalculator (PERK), which includes nudges to improve use and will be integrated into the electronic medical record and will be accessible for 6 months

Primary Outcome Measures

Name	Time	Method
Percentage of Patient Visits Where the Provider Adopted the Pulmonary Embolism Risk Kalculator (PERK) Tool	Up to Month 6	The tool is considered adopted during a patient visit if the provider accepted the recommendation given by the PERK tool (i.e., a D-dimer was recommended and ordered or a CT pulmonary angiogram (CTPA) was recommended and ordered). This outcome measure is assessed using electronic health record (EHR) data from the patient visit.

Secondary Outcome Measures

Name	Time	Method
Percentage of PE-Designated CTPA Tests That Are Positive for PE	Up to Month 6	Monitored using EHR reporting data. Calculated as the percentage of CTPA tests ordered to evaluate for PE that are positive for PE.

Trial Locations

Locations (2)

Huntington Hospital; 🇺🇸 Huntington, New York, United States

Long Island Jewish Valley Stream; 🇺🇸 Valley Stream, New York, United States