NCT04289753

Behavioral Economics Applications to Geriatrics Leveraging EHRs R33 Trial

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 37,134 (actual)
• Sponsor: Northwestern University · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

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.

Conditions

• Prostate Specific Antigen Screening
• Asymptomatic Bacteriuria
• Type 2 Diabetes

Interventions

Type	Name	Description
BEHAVIORAL	EHR clinical decision support nudges	Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria.
BEHAVIORAL	Brief clinician education	Clinicians will be invited to view brief education material.

Timeline

• Start date: 2020-09-01
• Primary completion: 2022-03-01
• Completion: 2022-09-30
• First posted: 2020-02-28
• Last updated: 2023-08-16
• Results posted: 2023-08-16

Locations

1 site across 1 country: United States