A Randomized Trial of a BE-EHR Module to Guide the Care of Older Adults With Diabetes
Study Details
Study Description
Brief Summary
This RCT will test a new electronic health record module to improve guideline-compliant care of older adults with diabetes. The module incorporates effective behavioral economics (BE) principles to improve the degree to which care of older adults is compliant with Choosing Wisely (CW) guidelines; this generally involves less aggressive targets for HbA1c, and reductions of medications other than metformin. The implementation of the module is triggered by patient scheduling and medication prescribing in EPIC. The BE principles include suggesting alternatives to medications, requiring justification, setting of appropriate default order sets, and incorporation of anchoring and checklists to guide behavior.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: standard EPIC instantiation As per standard procedure at NewYorkUniversity Langone Health |
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| Experimental: standard EPIC instantiation plus the BE-EHR module. The BE-EHR module includes six components: 1) a tailored advisory for patients over 75 with diabetes, 2) medication refill protocol with information on Choosing Wisely guidelines, 3) pre-population of the medication preference list with metformin, 4) lab result protocol with information on Choosing Wisely guidelines, 5) peer comparisons regarding performance meeting guidelines, and 6) media campaign with information about Choosing Wisely guidelines. The set of nudges is referred to collectively as the BE-EHR module. |
Behavioral: BE-EHR module
The BE-EHR module includes six components: 1) a tailored advisory for patients over 75 with diabetes, 2) medication refill protocol with information on Choosing Wisely guidelines, 3) pre-population of the medication preference list with metformin, 4) lab result protocol with information on Choosing Wisely guidelines, 5) peer comparisons regarding performance meeting guidelines, and 6) media campaign with information about Choosing Wisely guidelines. The set of nudges is referred to collectively as the BE-EHR module.
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Outcome Measures
Primary Outcome Measures
- Changes in Choosing Wisely compliance status [throughout the study, at the end of the 18 months study]
In order to evaluate Choosing Wisely compliance status, the BE-EHR algorithm will capture information on demographics, diagnoses in the patient's problem list, prescription history, and relevant lab results (i.e. allergies and blood glucose (HbA1c)) The study team members will not collect this information directly; data will be collected in NYULH's EHR system, EPIC, and an EPIC Reporting analyst will extract the relevant parameters from the EHR into a report. The study team members only receive the ultimate determination from the algorithm that the patient is either CW-compliant or CW-noncompliant.
Secondary Outcome Measures
- Changes in Tailored Advisory module [throughout the study, at the end of the 18 months study]
The Tailored Advisory nudge activates in Epic for any patient who is not CW compliant. For each patient seen, clinicians can respond by clicking the "Agree with recommendation. Action taken" button, or by selecting the "Clinically inappropriate. Please explain" option, with space for free text comments. A response is not required.
- Changes in Refill Protocol module [throughout the study, at the end of the 18 months study]
The Refill Protocol nudge activates in Epic any time a medication refill for either Metformin or a non-Metformin diabetes medication is generated for a patient over 75
- Changes in Preference List module [throughout the study, at the end of the 18 months study]
The Preference List nudge is a system level nudge at the pilot sites. Metformin is listed at the top of the page as the choice for "First-line Type 2 Diabetes," without restricting orders for non-Metformin medications
- Changes in Lab Result module [throughout the study, at the end of the 18 months study]
The Lab Result nudge activates in Epic whenever there is a new A1c lab result for a non-CW compliant patient; the alert remains active in Epic for seven days following the result.
- Changes in Peer Comparison module [throughout the study, at the end of the 18 months study]
The Peer Comparison nudge is sent via a secured Microsoft Outlook account once per month. The subject line of the email is "Message from the desk of Dr. [Insert Practice Director Name]" and the email content includes three graphics: a CW compliance rate for the individual provider, a CW compliance rate for the clinician's practice site, and a CW compliance rate across all NYU Langone practices. Depending on whether the clinician's CW compliance rate was above or below the rate of their respective practice, the provider receives either a "negative" or "positive" version of the email
- Changes in Campaign module [throughout the study, at the end of the 18 months study]
The campaign toolkit for dissemination includes three gameshow-themed animations (Price is Right, Jeopardy, and Who Wants to Be a Millionaire), as well as a flashcard deck that quizzes physicians on CW best practices. The Price is Right campaign includes three unique variations and the Jeopardy campaign includes four unique variations.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patient at NYULH primary care or endocrinology practice
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Practices that have patients aged 75 or older
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Practices that have a diagnosis of diabetes in the EHR chart
Exclusion Criteria:
• Under age 75
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | NYU Langone Health | New York | New York | United States | 10016 |
Sponsors and Collaborators
- NYU Langone Health
Investigators
- Principal Investigator: Andrea Troxel, ScD, NYU Langone
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 19-01464