Evaluation of Alerts in Promoting Bone Densitometry Scans

Study Overview
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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.

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.

Official Title
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Evaluation of Best Practice Alerts and an Actionable Sidebar in Electronic Health Records in Promoting Bone Densitometry Scans

Conditions
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Bone Diseases, Communication

Intervention / Treatment
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* Behavioral: Health Maintenance Topic
* Behavioral: Actionable Sidebar Item
* Behavioral: Best Practice Alert


Participation Criteria
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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) Exclusion Criteria: Encounters at clinics/sites where the randomization build cannot easily be deployed

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: 1 x 2 factorial design, with randomization happening at the patient level
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard of Care<br>A health maintenance topic, actionable sidebar item, and a single-click best practice alert are presented. | Behavioral: Health Maintenance Topic<br>* Alert<br>* Other names: HMT;Behavioral: Actionable Sidebar Item<br>* Alert<br>* Other names: Storyboard;Behavioral: Best Practice Alert<br>* Alert<br>* Other names: BPA;|
| Experimental: Silent Best Practice Alert<br>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. | Behavioral: Health Maintenance Topic<br>* Alert<br>* Other names: HMT;Behavioral: Actionable Sidebar Item<br>* Alert<br>* Other names: Storyboard;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bone Densitometry Scan Order Placed | Binary variable indicating whether or not the order was placed | 6 months or as long as it takes to reach N=4,200, whichever occurs first | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bone Densitometry Scan Completed | Binary variable indicating whether or not the order placed at the encounter was completed | 6 months or as long as it takes to reach N=4,200, whichever occurs first | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bone Diseases, Alerts, Densitometry, Dual Energy X-ray Absorptiometry Scan