Behavioral Economics Applications to Geriatrics Leveraging EHRs R33 Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 37,134
- 试验地点
- 1
- 主要终点
- Diabetes Overtreatment in the Elderly
研究概览
简要总结
Investigators will evaluate clinical decision support nudges informed by behavioral science and directed at primary care clinicians. These will be used to reduce commonly misused, and potentially harmful, diagnostic and therapeutic actions that occur in the care of older adults (e.g. overtreatment of type 2 diabetes, misuse of PSA screening, misuse of urine testing in women with nonspecific symptoms or no symptoms.
详细描述
Diagnostic and therapeutic strategies misapplied to older adults can lead to increased morbidity and mortality. Despite recommendations from the American Geriatrics Society for the Choosing Wisely Initiative, there are clear examples where clinicians do not often follow best practices leading to patient harm. These include: (1) testing and treatment for asymptomatic bacteriuria (ASB) in older women, (2) prostate specific antigen (PSA) screening in older men, and (3) aggressive treatment with insulin or oral hypoglycemics for type 2 diabetes.
Clinical decision support nudges, informed by behavioral economics and social psychology and delivered via electronic health records (EHRs), are promising strategies to reduce the misuse of services. Behavioral economics-informed interventions influence conscious and unconscious drivers of decision making, are low cost, and can be incorporated into existing systems.
This randomized controlled trial will evaluate the effects of three clinical decision support nudges on three clinical quality measures, indicators of patient safety, and clinician attitudes.
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
- Single (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
- •Northwestern Medicine primary care clinician who sees patients under department code of a randomized clinic
排除标准
- •Resident physicians will be excluded
- •Clinicians who participated in pilot study of these interventions
- •Clinician study investigators
研究组 & 干预措施
Brief clinician education
Clinicians attributed to clinics in the brief clinician education arm will receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months.
干预措施: Brief clinician education (Behavioral)
Clinical decision support nudges and brief clinician education
Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months.
干预措施: EHR clinical decision support nudges (Behavioral)
Clinical decision support nudges and brief clinician education
Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months.
干预措施: Brief clinician education (Behavioral)
结局指标
主要结局
Diabetes Overtreatment in the Elderly
时间窗: 18 months
Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus.
PSA Screening in Older Men
时间窗: 18 months
Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer.
Urine Testing for Non-specific Reasons
时间窗: 18 months
Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period.
次要结局
- Rate of UTI Requiring Hospital Care Among Women 65 and Over Following Clinical Decision Support Exposure(18 months)
- Rate of Poor Diabetes Control Among Previously Tightly Controlled(18 months)
- Rate of Hyperglycemia Requiring Hospital Care Following Clinical Decision Support Exposure(18 months)
- Rate of UTI Requiring Hospital Care Among Women 65 and Over Following an Office Visit(18 months)
- Rate of Hypoglycemia Requiring Urgent Care Among Previously Tightly Controlled(18 months)
- Rate of Hyperglycemia Requiring Hospital Care Among Previously Tightly Controlled(18 months)
研究者
Stephen Persell, MD, MPH
Professor of Medicine
Northwestern University