Active Choice in the EHR to Promote Statin Therapy

Not Applicable

Completed

Brief Summary: Cardiovascular (CV) events are the leading cause of mortality in the United States. Statins have been demonstrated to be an effective tool for reducing CV events and mortality, but statins are often either not prescribed or under-prescribed for patients that meet evidence-based guidelines. In this study, we will evaluate a health system initiative using active and passive choice prompts in the electronic health record to prompt cardiologists to prescribe evidence-based statin therapy. In partnership with the health system, this will be conducted as a randomized, controlled trial to evaluate its effect.

Detailed Description: This study will use a randomized, controlled trial to evaluate a health system initiative. Cardiologists randomly assigned to the control arm will receive no interventions. For cardiologists randomly assigned to the active choice intervention, the electronic health record will be used to prompt cardiologists to initiate or change statin therapy for patients not on evidenced-based guidelines based on the 2013 American College of Cardiology / American Heart Association (ACC/AHA) and the National Lipid Association (NLA) through a "best practice alert" in Epic which appears on the screen and forces a decision before the clinician can move on. For cardiologists randomly assigned to the passive choice intervention, the electronic health record will be used to create a passive alert using the same evidence-based guidelines. The passive alert will not block clinician workflow and instead will be available in the background for the cardiologist to open and then use to make a prescribing decision. The intervention period will be 6 months in duration.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Allergy to statins
Severe renal insufficiency defined as glomerular filtration rate (GFR) less than 30 mL/min or on dialysis
Adverse reaction to statins including a) myopathy, b)rhabdomyolysis, c)hepatitis
Pregnant
On a PCSK9 Inhibitor medication

Arm && Interventions

Group	Intervention	Description
Active choice	Active choice	Cardiologists in this arm will be exposed to an active choice intervention through the electronic health record (EHR) using an alert to prompt recommendations for statin therapy for patients not on guideline-based therapy. Cardiologists will be have to make an active choice to prescribe a statin at the recommended dose or not.
Passive choice	Passive choice	Cardiologists in this arm will be exposed to a passive choice alert within the EHR, using the same evidence-based guidelines as in the active choice arm. The passive alert will not block clinician workflow and instead will be available in the background for the cardiologist to open and then use to make a prescribing decision.

Primary Outcome Measures

Name	Time	Method
Change in the percent of eligible patients prescribed statin therapy at a dose that meets evidence-based guidelines	6 Months	Among patients not on guideline-based statin dosages, the percent that are prescribed guideline-based therapy at appropriate dose.

Secondary Outcome Measures

Name	Time	Method
Change in percentage of eligible patients prescribed a statin, at any dose.	6 Months	Among patients not on a statin, the percent that are prescribed guideline-based therapy, at any dose.

Locations (1): University of Pennsylvania
🇺🇸
Philadelphia, Pennsylvania, United States

Receive instant email notifications about changes in this clinical trial

Receive instant email notifications about changes in this clinical trial