NCT05656560

Reducing High-Risk Geriatric Polypharmacy Via EHR Nudges R01 Trial

Reducing High Risk Polypharmacy Using Behavioral Economics Through Electronic Health Records

• Status: Active Not Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 786 (actual)
• Sponsor: Northwestern University · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

High-risk polypharmacy is common among older adults in the United States, is particularly dangerous for individuals with dementia or cognitive impairment, and is associated with harms such as adverse drug reactions, falls, and higher costs of care. This project aims to test in a pragmatic clinic-randomized controlled trial two electronic health record-based behavioral economic nudges to help clinicians reduce high-risk polypharmacy among their older adult patients and in the subgroup with dementia or cognitive impairment. The main questions this trial aims to answer are: Aim 1: To evaluate the effects of an EHR-based commitment nudge, a justification nudge, and the combination of both nudges on a composite measure of high-risk polypharmacy via a pragmatic randomized controlled trial. The investigators will use cluster randomization in which primary care clinics are randomized to receive 0, 1, or 2 nudges using a factorial design. The nudges will run for 18 months, followed by 12 months of observation to assess persistence of effects. Aim 2: To qualitatively and quantitatively assess clinician experiences with the EHR-based nudges, including their acceptability and effects on workflow. At the conclusion of the intervention period, the investigators will perform semi-structured interviews and field a clinician survey.

Conditions

• Polypharmacy

Interventions

Type	Name	Description
BEHAVIORAL	Clinical decision support (CDS)-Commitment nudge	EHR clinical decision support alerts-clinician commitment to discuss high risk polypharmacy
OTHER	Clinician education	Brief, online education module for primary care clinicians
BEHAVIORAL	Clinical decision support (CDS)-Justification nudge	EHR clinical decision support alerts-clinician rational for high risk polypharmacy

Timeline

• Start date: 2023-06-08
• Primary completion: 2026-05-10
• Completion: 2026-05-31
• First posted: 2022-12-19
• Last updated: 2025-03-30

Locations

2 sites across 1 country: United States