Electronic Health Record Nudges to Improve Quality of Care in Heart Failure

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PROJECT SUMMARY/NARRATIVE This career development award will provide Dr. Faraz Ahmad with the opportunity to become an independent physician-scientist who develops and implements health information technologies that increase the uptake of evidence-based therapies and improve the quality of life and longevity for patients with heart failure. Dr. Ahmad is a practicing heart failure cardiologist and informaticist with a current research focus on the methodology of integrating diverse electronic health data to measure quality of care. This award will provide rigorous training in dissemination and implementation science, clinical decision support, and pragmatic clinical trial methodology that will enable him to design and test digital interventions to improve care quality. The training program includes the development of independent investigator skills required to lead interdisciplinary teams and mentor the next-generation of biomedical informatics and implementation science researchers. He will achieve these career goals through a comprehensive training program that combines intensive mentorship, formal coursework, workshops, conferences, and experiential learning. His primary mentor is Dr. Abel Kho, an expert in biomedical informatics, electronic clinical decision support tools, and quality improvement with an extensive record of mentoring. In addition, Dr. Donald Lloyd-Jones, one of the leaders in cardiovascular epidemiology with an exemplary mentorship record, will serve as a co-mentor and oversee Dr. Ahmad’s training in the essential skills of becoming a productive, independent physician-scientist. Finally, co-mentor Dr. J.D. Smith, an established mentor and implementation science methodologist, will provide expertise in pragmatic trial methodology. The rich resource environment of Northwestern University will facilitate the success of this proposed training and research project and includes: 1) dedicated support from the Department of Medicine and the Center for Health Information Partnerships; 2) an interdisciplinary team of mentors, advisors, and collaborators; 3) extensive skill courses, workshops, and seminars 4) research infrastructure including the world class, integrated Northwestern Medicine Electronic Data Warehouse, data analytics, and biostatistical support; and 5) support from a large, integrated academic health center and the Northwestern Medicine Quality Innovation Center. The overall purpose of the research is to pilot test a set of clinical decision support nudges to push clinicians to increase prescription and titration of evidence-based therapies for patients with heart failure with reduced ejection fraction, a highly morbid, prevalent, and costly condition with enormous gaps in quality of care. Specific Aim One will evaluate barriers to high quality of care for patients with heart failure and identify components of an ideal health information technology tool via a mixed methods approach in primary care and cardiology practices. Specific Aim Two will evaluate a set of nudges developed in a co-design workshop with key stakeholders. Specific Aim Three will test the feasibility of the set of nudges in a pilot feasibility trial.