Optimizing Proton Pump Inhibitors (PPI) Prescribing With EHR-Based Decision Support

University of California, Los Angeles (UCLA)

Status: Enrolling

Conditions: Physician's Practice Patterns; Prescribing Patterns, Physician; Drug Utilization Review

Treatments: Behavioral: Active Physician Choice; Behavioral: Algorithmic Defaulting (Indication-Based Default)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06998966

1K76AG064392-01A1 (U.S. NIH Grant/Contract)

IRB-25-0231

Details and patient eligibility

About

The proposed study is a quality improvement initiative designed to rigorously evaluate new variations of UCLA Health's proton pump inhibitor (PPI) order panels, building on internal quality improvement efforts to optimize prescribing workflows within the Electronic Health Record (EHR). PPIs are notoriously overprescribed, and the study team has identified that the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether modifying defaulted prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority.

This evaluation of PPI order panel variations is embedded within UCLA's existing EHR system, ensuring that changes are tested pragmatically within routine workflows. The study aims to determine whether small adjustments to the order panel can better align prescribing patterns with clinical best practices while maintaining physician autonomy.

Enrollment: 372 estimated patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• UCLA Health primary care physicians who have a clinical full-time equivalency of at least 25%.

Exclusion criteria

• Physicians with a clinical full-time equivalency of less than 25%

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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372 participants in 3 patient groups

Control

No Intervention group

Description:

•Physicians use an unchanged prescribing workflow for Proton Pump Inhibitors (PPI) medications, with no changes to default dosage or duration.

Algorithmic Defaulting (Indication-Based Default)

Experimental group

Description:

The Electronic Health Record (EHR) automatically evaluates whether the patient at hand meets guideline criteria for long-term vs. short-term Proton Pump Inhibitors (PPI) use and it selects a default PPI prescription duration. (Providers can override the defaulted duration if they disagree with the automated assessment.) The order panel displays each PPI option below one of the following duration choices: For short-term PPI, this includes patients with conditions like Gastroesophageal reflux disease (GERD). For long-term PPI, this includes patients with conditions requiring extended therapy (e.g. Barrett's esophagus, chronic NSAID use)

Treatment:

Behavioral: Algorithmic Defaulting (Indication-Based Default)

Active Physician Choice

Experimental group

Description:

•The order panel displays each PPI option below one of the following duration choices: For short-term PPI, this includes patients with conditions like GERD. For long-term PPI, this includes patients with conditions requiring extended therapy (e.g. Barrett's esophagus, chronic NSAID use). The order panel removes the default selection, thus requiring providers to actively select a prescription duration for each patient, given the guideline education presented in the panel.

Treatment:

Behavioral: Active Physician Choice