Clinical trial NCT04289753: Behavioral Economics Applications to Geriatrics Leveraging EHRs R33 Trial
Official title: Behavioral Economics Applications to Geriatrics Leveraging EHRs R33 Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Prostate Specific Antigen Screening
Asymptomatic Bacteriuria
Type 2 Diabetes
Keywords: Geriatrics
Quality of care
Lead sponsor: Northwestern University
Sponsor class: OTHER
Collaborators: name: University of Southern California
name: University of California, Los Angeles
name: National Institute on Aging (NIA)
First posted: 2020-02-28
Enrollment: 37134
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Cluster-randomized by primary care clinic using a constrained randomization process.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: PSA Screening in Older Men
timeFrame: 18 months
measure: Urine Testing for Non-specific Reasons
timeFrame: 18 months
measure: Diabetes Overtreatment in the Elderly
timeFrame: 18 months
Secondary outcomes:
measure: Rate of UTI Requiring Hospital Care Among Women 65 and Over Following Clinical Decision Support Exposure
timeFrame: 18 months
measure: Rate of UTI Requiring Hospital Care Among Women 65 and Over Following an Office Visit
timeFrame: 18 months
measure: Rate of Hyperglycemia Requiring Hospital Care Following Clinical Decision Support Exposure
timeFrame: 18 months
measure: Rate of Hyperglycemia Requiring Hospital Care Among Previously Tightly Controlled
timeFrame: 18 months
measure: Rate of Poor Diabetes Control Among Previously Tightly Controlled
timeFrame: 18 months
measure: Rate of Hypoglycemia Requiring Urgent Care Among Previously Tightly Controlled
timeFrame: 18 months
Other outcomes:
measure: PSA Screening in Older Men
timeFrame: 19-30 months
measure: Urine Testing for Non-specific Reasons
timeFrame: 19-30 months
measure: Diabetes Overtreatment in the Elderly
timeFrame: 19-30 months
measure: Rates of Prostate Biopsy
timeFrame: 18 months and 19-30 months
measure: Rate of Prostate MRI
timeFrame: 18 months and 19-30 months
measure: Rate of Prostate Cancer Diagnosis
timeFrame: 18 months and 19-30 months
measure: PSA Screening Done by Non PCP in Men Over 76 Years Old
timeFrame: 18 months and 19-30 months
measure: PSA Screening in Men Aged 55 to 69 and Age 70 to 75
timeFrame: 18 months and 19-30 months
measure: Rates of Urinalysis and Urine Culture Use in Women 65 and Older
timeFrame: 18 months and 19-30 months
measure: Rate of Treatment for Antibiotics for UTI in Women 65 and Older
timeFrame: 18 months and 19-30 months
measure: Dose Reduction in Insulin, Sulfonylurea or Meglitinides
timeFrame: 18 months, 24 months
measure: PSA Screening in Older Men by Race
timeFrame: 18 months
measure: PSA Screening in Older Men by Ethnicity
timeFrame: 18 months
measure: Urine Testing for Non-specific Reasons by Race
timeFrame: 18 months
measure: Urine Testing for Non-specific Reasons by Ethnicity
timeFrame: 18 months
measure: Diabetes Overtreatment in the Elderly by Sex
timeFrame: 18 months
measure: Diabetes Overtreatment in the Elderly by Race
timeFrame: 18 months
measure: Diabetes Overtreatment in the Elderly by Ethnicity
timeFrame: 18 months
Locations:
city: Chicago
country: United States
facility: Northwestern Medicine
state: Illinois
Study officials:
affiliation: Northwestern University
name: Stephen D. Persell, MD, MPH
role: PRINCIPAL_INVESTIGATOR
References: