Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE R21)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT03704389|
Recruitment Status : Active, not recruiting
First Posted : October 12, 2018
Last Update Posted : July 31, 2019
The risks and benefits of many diagnostic approaches and treatments differ for older adults compared to middle aged adults. When diagnostic and therapeutic strategies are misapplied to older adults this can lead to increased morbidity and mortality. Well established examples where clinicians do not often follow best practices in the care of older adults include those identified by the American Geriatrics Society for the Choosing Wisely initiative: 1) testing and treatment for asymptomatic bacteriuria, 2) prostate specific antigen testing in older men without prostate cancer, and 3) overuse of insulin or oral hypoglycemics for type 2 diabetes.
Clinical decision support nudges, informed by social psychology and delivered via electronic health records (EHRs), are promising strategies to reduce the misuse of services in cases where optimal utilization may not be zero but should be well below current practice. These interventions seek to influence conscious and unconscious drivers of clinical decision making, are low cost to implement and disseminate, and can be incorporated into existing delivery systems. In the R21 phase of this Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE) study, we will: select EHR delivered nudges to address 3 topics of potential misuse in older adults based on the main psychological drivers of overuse identified in interviews with high-using clinicians; develop and pilot test decision support tools within a health systems' EHR to understand technical feasibility, work flow fit, preliminary impact on clinical outcomes, and clinician acceptability; and develop and validate electronic clinical quality measures of potential overuse/misuse related to the care of older adults.
|Condition or disease||Intervention/treatment||Phase|
|Prostate Specific Antigen Asymptomatic Bacteriuria Type 2 Diabetes Mellitus||Behavioral: Clinical decision support||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||14 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Health Services Research|
|Official Title:||Behavioral Economics Applications to Geriatrics Leveraging EHRs|
|Actual Study Start Date :||January 17, 2019|
|Actual Primary Completion Date :||July 17, 2019|
|Estimated Study Completion Date :||August 18, 2019|
Experimental: Clinical decision support intervention
Participating clinicians will receive any of three clinical decision support nudges within the electronic health record when all eligibility criteria are met within a patient's chart.
Behavioral: Clinical decision support
Clinical decision support nudges within the electronic health record
- Misuse of urinalysis or urine culture in older women [ Time Frame: 6 months ]Proportion of women aged 65 years and older who underwent a urinalysis and/or urine culture for suspected UTI who did not have genitourinary specific symptoms
- PSA testing in the elderly [ Time Frame: 6 months ]Proportion of men 76 and older with no history of prostate cancer who had a PSA test done during the measurement period
- Diabetes overtreatment in the elderly [ Time Frame: 6 months ]Proportion of diabetes patients 75 and older treated with insulin or oral hypoglycemic with hemoglobin A1c less than 7.0.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03704389
|United States, Illinois|
|Chicago, Illinois, United States, 60611|