Preliminary Implementation of an Informational Nudge to Improve Heart Failure Prescribing

初步实施信息推动以改善心力衰竭处方

• 批准号: 10642641
• 负责人: Sandesh Dev
• 金额: --
• 依托单位: SOUTHERN ARIZONA VA HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10642641
• 关键词: Academic Detailing; Address; Adoption; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Cardiology; Cardiovascular system; Caring; Cessation of life; Clinical; Cognitive; Control Groups; Decision Making; Discipline; Drug Prescriptions; Effectiveness; Electronic Health Record; Eligibility Determination; Ensure; Environment; Evidence based practice; Feedback; Focus Groups; Glucose Transporter; Guidelines; Health; Healthcare; Heart Rate; Heart failure; Hospitalization; Hybrids; Informatics; Infrastructure; Intervention; Interview; Investigation; Knowledge; Literature; Methodology; Mineralocorticoid Receptor; Outcome; Patients; Periodicals; Pharmaceutical Preparations; Pilot Projects; Practical Robust Implementation and Sustainability Model; Practice Guidelines; Psychology; Quality of Care; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Research; Resources; Safety; Science; Sodium; Testing; Treatment Failure; Veterans; Work; antagonist; arm; behavior influence; comparative effectiveness; compare effectiveness; cost; data resource; design; effectiveness testing; evidence base; experience; formative assessment; implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation trial; improved; inhibitor; innovation; insight; meetings; mortality; multi-component intervention; novel; peer; prescription opioid; prevent; prototype; provider behavior; receptor; social norm; theories; treatment as usual

Background: VA has experience with strategies to promote guideline-concordant heart failure (HF) care but there is a need for greater innovation. Nudge theory is a field within behavioral science that focuses on the psychology of decision-making and offers a novel solution to improve health care. In this proposed study, we will evaluate two nudge interventions, alerts and peer comparison feedback, that exploit several biases which constitute the theoretical basis supporting behavioral change. Significance: The HF treatment gap is serious, costly, and all-too-common (low adoption of SGLT2i and MRAs). The rates of HF guideline-directed therapy have stagnated in the VA. Our group and others have reported that 34,000 and 21,000 deaths could be averted with optimal implementation of SGLT2i and MRAs, respectively, in the U.S. Innovation & Impact: We will test the effectiveness of a multicomponent nudge strategy (alert + peer comparison) which are rarely conducted compared to single component strategies. Only 10% of clinical-directed nudge interventions in the literature are multicomponent, and none were identified in the VA. This study will create knowledge on how to combine these different strategies which are needed to advance the field further and efficiently allocate VA resources. This study targets an HF treatment gap (SGLT2 and MRA) in which no prior nudge studies have demonstrated efficacy. This proposal utilizes an implementation science (CDS/PRISM) approach to develop nudge strategies which is needed to ensure optimal effectiveness, implementation, and sustainability. Specific Aims: 1) Conduct a formative evaluation to develop two nudge strategies, an informational alert and peer comparison feedback, to encourage clinicians to prescribe MRA and SGLT2 inhibitors. 2) Evaluate preliminary outcomes of the two nudge strategies using the RE-AIM framework. a) Evaluate the preliminary effectiveness of the alert and peer comparison strategies in a four-group design. b) Evaluate the implementation outcomes of the two nudge strategies. i) We will report the following PRISM/RE-AIM outcomes: intervention, recipients, external environment, infrastructure, Reach, Adoption, and Implementation. Methodology: This is a single-center pilot study. For Aim 1, we will conduct key stakeholder interviews and focus groups of clinicians to assess barriers and facilitators to SGLT2 and MRA prescribing and to refine the prototype nudges. For Aim 2, clinicians will be randomized to one of four arms: usual care, informational alert, peer comparison feedback, and combination of alert and peer comparison. We will compare Effectiveness, defined as new prescription of SGLT2 or MRA within 30 days, in the three intervention versus control groups. We will also report other outcomes including safety, Reach, Adoption, and Implementation. Next Steps/Implementation: We will plan to test the nudge strategies in a broader trial of multiple VAMCs using information gained from this study to inform implementation. We will work with our partners in National Cardiology and PBM Academic Detailing to disseminate our findings, and they will be included in periodic stakeholders’ meetings during the study.

背景：VA有促进指南一致性心力衰竭的策略经验