Reducing High-Risk Geriatric Polypharmacy Via EHR Nudges: Pilot Phase
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease, Renal Impairment / Chronic Kidney Disease, Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Nephrology / Urology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/28/2019 |
| Start Date: | February 11, 2019 |
| End Date: | September 1, 2019 |
Polypharmacy is common among older adults in the United States and is associated with harms
such as adverse drug reactions and higher costs of care. This pilot-phase project is designed
to test two electronic health record (EHR)-based behavioral economic nudges to help primary
care clinicians reduce the rate of high-risk polypharmacy among their older adult patients.
such as adverse drug reactions and higher costs of care. This pilot-phase project is designed
to test two electronic health record (EHR)-based behavioral economic nudges to help primary
care clinicians reduce the rate of high-risk polypharmacy among their older adult patients.
Polypharmacy increases the likelihood of being prescribed and harmed by high-risk
medications. As noted in the 2014 National Action Plan for Adverse Drug Event (ADE)
Prevention, polypharmacy both increases the likelihood of being prescribed high-risk
medications and increases the likelihood that these high-risk medications will lead to
adverse drug events. This pilot-phase study is intended to test clinicians' perceptions of
EHR-based nudges designed to reduce high-risk polypharmacy among patients aged 65 years or
more, thereby enabling investigators to refine the nudges, and to generate outcomes data that
will inform power calculations for a subsequent larger study (the main study) of the nudges'
effectiveness.
In this pilot-phase study, the investigators will deploy 2 EHR-based behavioral nudges (a
commitment nudge and a justification nudge) among 18 or more primary care clinicians in 3
primary care practices (6 clinicians or more per practice) affiliated with Northwestern
University for approximately 4 months. The 3 practices participating in the pilot will be a
convenience sample of Northwestern-affiliated practices known to study investigators.
The investigators will randomly assign each of the 3 participating pilot practices to 1 of 3
arms: (1) commitment nudge, (2) justification nudge, or (3) both commitment and justification
nudges. Randomization will be at the practice level, without replacement, thus assigning
exactly 1 practice to each arm. All participating clinicians within a given practice will
receive the same nudges.
Northwestern-affiliated practices that do not participate in the pilot will constitute a
fourth arm of this pilot study.
The investigators will ask leaders of participating practices for their qualitative
observations on how clinicians and patients experience the nudges (e.g., how the nudges
affect workflows). The investigators also will collect data on the outcome measures before
and during the approximately 4-month pilot period and compare these data to contemporaneous
outcomes measures generated by Northwestern-affiliated practices that do not participate in
the pilot.
medications. As noted in the 2014 National Action Plan for Adverse Drug Event (ADE)
Prevention, polypharmacy both increases the likelihood of being prescribed high-risk
medications and increases the likelihood that these high-risk medications will lead to
adverse drug events. This pilot-phase study is intended to test clinicians' perceptions of
EHR-based nudges designed to reduce high-risk polypharmacy among patients aged 65 years or
more, thereby enabling investigators to refine the nudges, and to generate outcomes data that
will inform power calculations for a subsequent larger study (the main study) of the nudges'
effectiveness.
In this pilot-phase study, the investigators will deploy 2 EHR-based behavioral nudges (a
commitment nudge and a justification nudge) among 18 or more primary care clinicians in 3
primary care practices (6 clinicians or more per practice) affiliated with Northwestern
University for approximately 4 months. The 3 practices participating in the pilot will be a
convenience sample of Northwestern-affiliated practices known to study investigators.
The investigators will randomly assign each of the 3 participating pilot practices to 1 of 3
arms: (1) commitment nudge, (2) justification nudge, or (3) both commitment and justification
nudges. Randomization will be at the practice level, without replacement, thus assigning
exactly 1 practice to each arm. All participating clinicians within a given practice will
receive the same nudges.
Northwestern-affiliated practices that do not participate in the pilot will constitute a
fourth arm of this pilot study.
The investigators will ask leaders of participating practices for their qualitative
observations on how clinicians and patients experience the nudges (e.g., how the nudges
affect workflows). The investigators also will collect data on the outcome measures before
and during the approximately 4-month pilot period and compare these data to contemporaneous
outcomes measures generated by Northwestern-affiliated practices that do not participate in
the pilot.
Inclusion Criteria:
- Primary care clinicians practicing in one of the participating Northwestern-affiliated
practices
Exclusion Criteria:
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