A Randomized Trial of a BE-EHR Module to Guide the Care of Older Adults With Diabetes

NYU Langone Health

Status: Completed

Conditions: Diabetes

Treatments: Behavioral: BE-EHR module

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04181307

5R33AG057382 (U.S. NIH Grant/Contract)

19-01464

Details and patient eligibility

About

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.

Enrollment: 7,630 patients

Sex: All

Ages: 75+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patient at NYULH primary care or endocrinology practice
• Practices that have patients aged 75 or older
• Practices that have a diagnosis of diabetes in the EHR chart

Exclusion criteria

• Under age 75

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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7,630 participants in 2 patient groups

standard EPIC instantiation

No Intervention group

Description:

As per standard procedure at NewYorkUniversity Langone Health

standard EPIC instantiation plus the BE-EHR module.

Experimental group

Description:

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.

Treatment:

Behavioral: BE-EHR module