Reducing High-Risk Geriatric Polypharmacy Via EHR Nudges: Pilot Phase

Summary

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.

Conditions

• Fall
• Congestive Heart Failure
• Chronic Kidney Failure
• Adverse Drug Event

Interventions

BEHAVIORAL

Commitment nudge

The commitment nudge will ask clinicians to commit to discussing high-risk polypharmacy at the next office visit with patients who have high-risk polypharmacy. Clinicians who commit will receive a reminder just before the next office visit begins. The patient will also receive notification of the commitment via EHR patient portal. This nudge will be operationalized via two sequential clinician-facing EHR best practice alerts (BPAs): the first at time of opening any encounter (including encounters other than a face-to-face office visit, e.g., medication refills), and the second (contingent on making a commitment to discuss high-risk polypharmacy) at time of opening the subsequent encounter for a face-to-face office visit. Each of these BPAs will describe the specific high-risk polypharmacy criterion (or criteria) the patient meets, the specific harms associated with the medication(s) triggering the criterion/criteria, and lower-risk alternative treatment strategies.

BEHAVIORAL

Justification nudge

The justification nudge will ask clinicians who prescribe or renew a drug that meets high-risk polypharmacy criteria (in the context of the patient's other medications) to write a brief justification for prescribing this high-risk medication. This written justification will be recorded in the patient's medical record. The best practice alert requesting the justification will also describe the specific high-risk polypharmacy criterion (or criteria) the patient meets, the specific harms associated with the medication(s) triggering the criterion/criteria, and lower-risk alternative treatment strategies.

Sponsors & Collaborators

• Northwestern University

  collaborator OTHER

• University of California, Los Angeles

  collaborator OTHER

• University of Southern California

  collaborator OTHER

• University of Pittsburgh

  collaborator OTHER

• National Institute on Aging (NIA)

  collaborator NIH

• RAND

  lead OTHER

Principal Investigators

• Mark W Friedberg, MD, MPP · RAND

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

FACTORIAL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2019-02-01

Primary Completion

2019-08-01

Completion

2019-09-01

Countries

• United States

Study Locations