Clinical trial NCT04955652: Evaluation of Alerts in Promoting Bone Densitometry Scans
Official title: Evaluation of Best Practice Alerts and an Actionable Sidebar in Electronic Health Records in Promoting Bone Densitometry Scans
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: NA
Conditions: Bone Diseases
Communication
Keywords: Bone Diseases
Alerts
Densitometry
Dual Energy X-ray Absorptiometry Scan
Lead sponsor: Geisinger Clinic
Sponsor class: OTHER
First posted: 2021-07-09
Enrollment: 0
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: 1 x 2 factorial design, with randomization happening at the patient level
Primary purpose: PREVENTION

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Bone Densitometry Scan Order Placed
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
Secondary outcomes:
measure: Bone Densitometry Scan Completed
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
Other outcomes:
measure: Bone Densitometry Scan Completion Time
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
measure: Number of Unique Alerts
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
measure: Number of Alerts Fired
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
measure: Total number of BPAs
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
measure: Total number of medication alerts
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
measure: Total number of passive alerts
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
measure: Total number of interruptive alerts
timeFrame: 6 months or as long as it takes to reach N=4,200, whichever occurs first
Locations:
Study officials:
affiliation: Program Director, Behavioral Insights Team
name: Amir Goren, PhD
role: PRINCIPAL_INVESTIGATOR
References: