Behavioral Economics Applications to Geriatrics Leveraging EHRs R33 Trial (BEAGLE R33)

Northwestern University

Status: Completed

Conditions: Asymptomatic Bacteriuria; Prostate Specific Antigen Screening; Type 2 Diabetes

Treatments: Behavioral: Brief clinician education; Behavioral: EHR clinical decision support nudges

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04289753

STU00210358

R33AG057383 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

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.

Full 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.

Enrollment: 37,134 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Northwestern Medicine primary care clinician who sees patients under department code of a randomized clinic

Exclusion criteria

• Resident physicians will be excluded
• Clinicians who participated in pilot study of these interventions
• Clinician study investigators

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

37,134 participants in 2 patient groups

Brief clinician education

Active Comparator group

Description:

Clinicians attributed to clinics in the brief clinician education arm will receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months.

Treatment:

Behavioral: Brief clinician education

Clinical decision support nudges and brief clinician education

Experimental group

Description:

Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months.

Treatment:

Behavioral: EHR clinical decision support nudges

Behavioral: Brief clinician education