Evaluation of Alerts in Promoting Bone Densitometry Scans

Not Applicable

Withdrawn

• Conditions: Bone Diseases; Communication
• Interventions: Behavioral: Health Maintenance Topic; Behavioral: Actionable Sidebar Item; Behavioral: Best Practice Alert

• Registration Number: NCT04955652
• Lead Sponsor: Geisinger Clinic

Brief Summary

The purpose of this study is to assess, prospectively, the effect of provider-facing alerts for bone densitometry scans with and without a single-click best practice alert (BPA) on scan orders and completions. The investigators hypothesize that the remaining alerts left in place (via health maintenance topics and an actionable item in the electronic health record sidebar) will be as effective without the BPA compared to the alerts with a BPA.

Detailed Description

Standard care for bone densitometry scans at Geisinger--i.e., dual-energy x-ray absorptiometry (DXA) scans--involves (1) an alert under the health maintenance topics tab in Epic, (2) an actionable item in a sidebar (Storyboard), (3) and a single-click best practice alert (BPA). Storyboard and the BPA theoretically serve a redundant function, but it is possible that combined alerting is effective. Therefore, the investigators plan to evaluate whether the BPA for DXA scans will increase the percentage of DXA scans ordered and completed.

For this evaluation, the investigators will randomly assign (by odd and even MRN) half of patients who need DXA scans to go through standard care (including the single-click BPA) and half of patients to have no BPA shown to their provider, but only the health maintenance topic and actionable Storyboard alert. This evaluation will help the investigators determine whether redundant, more traditional alerts such as BPAs are helpful or can be removed from alerts for DXA scans.

The randomization of patients to different alert conditions will be in place until 4,200 participants have been reached (estimated sample to detect 4% absolute difference, rounded to nearest hundred) or 6 months, whichever comes first. To account for delays in updating clinical databases, the outcome data will pulled 3 months after each encounter (for a maximum study period of 9 months).

The main analysis will use a logistic regression to compare the two groups. Exploratory analyses will also examine the time from order to completion to examine any effect on timing between arms. Another set of exploratory analyses will also examine the number of other BPAs firing to see if alert fatigue influenced the number of orders or completions or interacted with the experimental conditions.

Study Timeline

• Study First Submitted: 2021-06-22
• Study First Submitted QC: 2021-06-29
• Study First Posted: 2021-07-09
• Status Verified: 2022-03
• Study Start: 2022-03
• Last Update Submitted: 2022-03-16
• Last Update Posted: 2022-03-31
• Primary Completion: 2022-12
• Study Completion: 2022-12

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: Female
• Target Recruitment: Not specified

Inclusion Criteria

• In primary care
• Records indicate patient is due for a bone densitometry scan (generally, a high-risk patient that requires this scan or age 65 and older)

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Exclusion Criteria

• Encounters at clinics/sites where the randomization build cannot easily be deployed

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Standard of Care	Best Practice Alert	A health maintenance topic, actionable sidebar item, and a single-click best practice alert are presented.
Standard of Care	Health Maintenance Topic	A health maintenance topic, actionable sidebar item, and a single-click best practice alert are presented.
Silent Best Practice Alert	Health Maintenance Topic	A health maintenance topic and an actionable sidebar item are presented. The best practice alert is set to be silent and will not appear in the patient's chart.
Standard of Care	Actionable Sidebar Item	A health maintenance topic, actionable sidebar item, and a single-click best practice alert are presented.
Silent Best Practice Alert	Actionable Sidebar Item	A health maintenance topic and an actionable sidebar item are presented. The best practice alert is set to be silent and will not appear in the patient's chart.

Primary Outcome Measures

Name	Time	Method
Bone Densitometry Scan Order Placed	6 months or as long as it takes to reach N=4,200, whichever occurs first	Binary variable indicating whether or not the order was placed

Secondary Outcome Measures

Name	Time	Method
Bone Densitometry Scan Completed	6 months or as long as it takes to reach N=4,200, whichever occurs first	Binary variable indicating whether or not the order placed at the encounter was completed