Behavioral Economics Applications to Geriatrics Leveraging EHRs R33 Trial

NCT ID: NCT04289753

Last Updated: 2023-08-16

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

37134 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-01

Study Completion Date

2022-09-30

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Prostate Specific Antigen Screening Asymptomatic Bacteriuria Type 2 Diabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Cluster-randomized by primary care clinic using a constrained randomization process.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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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.

Group Type ACTIVE_COMPARATOR

Brief clinician education

Intervention Type BEHAVIORAL

Clinicians will be invited to view brief education material.

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.

Group Type EXPERIMENTAL

EHR clinical decision support nudges

Intervention Type BEHAVIORAL

Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria.

Brief clinician education

Intervention Type BEHAVIORAL

Clinicians will be invited to view brief education material.

Interventions

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EHR clinical decision support nudges

Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria.

Intervention Type BEHAVIORAL

Brief clinician education

Clinicians will be invited to view brief education material.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Northwestern Medicine primary care clinician who sees patients under department code of a randomized clinic

Exclusion Criteria

* Resident physicians will be excluded
* Clinicians who participated in pilot study of these interventions
* Clinician study investigators
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Southern California

OTHER

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role collaborator

National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

Northwestern University

OTHER

Sponsor Role lead

Responsible Party

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Stephen Persell, MD, MPH

Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Stephen D. Persell, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Northwestern University

Locations

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Northwestern Medicine

Chicago, Illinois, United States

Site Status

Countries

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United States

References

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Persell SD, Petito LC, Lee JY, Meeker D, Doctor JN, Goldstein NJ, Fox CR, Rowe TA, Linder JA, Chmiel R, Peprah YA, Brown T. Reducing Care Overuse in Older Patients Using Professional Norms and Accountability : A Cluster Randomized Controlled Trial. Ann Intern Med. 2024 Mar;177(3):324-334. doi: 10.7326/M23-2183. Epub 2024 Feb 6.

Reference Type DERIVED
PMID: 38315997 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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R33AG057383

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STU00210358

Identifier Type: -

Identifier Source: org_study_id

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