Evaluation of Alerts in Promoting Bone Densitometry Scans

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-31

Study Completion Date

2022-12-31

Brief Summary

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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.

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Detailed Description

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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.

Conditions

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Bone Diseases Communication

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

1 x 2 factorial design, with randomization happening at the patient level

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Caregivers

The participants and providers will not know that alerts were randomized. Participants will not know the arm to which they were assigned. Providers might notice that a given participant did or did not receive a certain alert, but this is expected to be unlikely, given the volume of alerts to which providers are exposed constantly.

Study Groups

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Standard of Care

A health maintenance topic, actionable sidebar item, and a single-click best practice alert are presented.

Group Type ACTIVE_COMPARATOR

Health Maintenance Topic

Intervention Type BEHAVIORAL

Alert

Actionable Sidebar Item

Intervention Type BEHAVIORAL

Alert

Best Practice Alert

Intervention Type BEHAVIORAL

Alert

Silent Best Practice Alert

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.

Group Type EXPERIMENTAL

Health Maintenance Topic

Intervention Type BEHAVIORAL

Alert

Actionable Sidebar Item

Intervention Type BEHAVIORAL

Alert

Interventions

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Health Maintenance Topic

Alert

Intervention Type BEHAVIORAL

Actionable Sidebar Item

Alert

Intervention Type BEHAVIORAL

Best Practice Alert

Alert

Intervention Type BEHAVIORAL

Other Intervention Names

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HMT Storyboard BPA

Eligibility Criteria

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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)