Using Active Choice in the EHR to Promote Cardiologists to Prescribe Evidence-Based Statin Therapy
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 23,066
- 试验地点
- 2
- 主要终点
- Change in the percent of eligible patients prescribed statin therapy at a dose that meets evidence-based guidelines
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Have a cardiologist at the University of Pennsylvania Health System
- •Meets 2013 ACC/AHA or NLA guidelines for statin prescription
排除标准
- •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
- •On a PCSK9 Inhibitor medication
研究组 & 干预措施
Usual care
Cardiologists in this arm will receive no interventions and will act as usual care
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.
干预措施: Active choice (Behavioral)
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.
干预措施: Passive choice (Behavioral)
结局指标
主要结局
Change in the percent of eligible patients prescribed statin therapy at a dose that meets evidence-based guidelines
时间窗: 6 Months
Among patients not on guideline-based statin dosages, the percent that are prescribed guideline-based therapy at appropriate dose.
次要结局
- Change in percentage of eligible patients prescribed a statin, at any dose.(6 Months)