Pragmatic, Randomized Evaluation of Statin Active Choice to Reach Improved Outcomes Based on Evidence

Study Overview
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Brief Summary
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In this study, the investigators will conduct a pragmatic, cluster-randomized, controlled trial to evaluate an active choice intervention with and without social comparison feedback to increase physician statin prescribing rates for eligible patients.

Detailed Description
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Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Strong evidence indicates that statin medications can reduce the risk of CVD and for those with CVD statins have been shown to reduce mortality. Despite this evidence, statins are under-prescribed. In this study, the investigators will test the effectiveness of nudges targeted to physicians using active choice and social comparisons feedback to increasing the rate at which statin medications are prescribed to patients eligible based on national practice guidelines.

Official Title
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Pragmatic, Randomized Evaluation of Statin Active Choice to Reach Improved Outcomes Based on Evidence

Conditions
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Cardiovascular Diseases

Intervention / Treatment
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* Behavioral: Active choice
* Behavioral: Social comparison feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient has a primary care physician at University of Pennsylvania Health System Patient meets 2013 AHA/ACC guidelines for statin therapy but no record of a statin prescription in the electronic health record Exclusion Criteria: Patient has an allergy or adverse reaction to statins documented in the electronic health record Patient has glomerular filtration rate less than 30 mL/min Physicians (and their respective patients) will be excluded if they have less than 10 patients among their entire panel that are eligible for a statin

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

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: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>No intervention | |
| Experimental: Active choice<br>Physicians will be asked to review a list of their patients eligible for statin therapy who are not yet prescribed a statin and make an active choice whether or not to prescribe a statin. | Behavioral: Active choice<br>* Statin options are framed to physicians as an active choice to prescribe or not prescribe a statin<br>|
| Experimental: Active choice with social comparison feedback<br>Physicians will be asked to review a list of their patients eligible for statin therapy who are not yet prescribed a statin and make an active choice whether or not to prescribe a statin. Physicians will receive social comparison feedback informing them of how their performance compares to their peers | Behavioral: Active choice<br>* Statin options are framed to physicians as an active choice to prescribe or not prescribe a statin<br>Behavioral: Social comparison feedback<br>* Statin prescribing rates are communicated to physicians and along with how their performance compares to their peers<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Statin Prescribing Rate | Percentage of patients eligible for a statin that have been prescribed a statin | Two Months |