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：退伍军人管理局在促进指南一致性心力衰竭的策略方面有经验 (Hf)护理，但需要更大的创新。轻推理论是行为学中的一个领域 专注于决策心理学并为改进提供新的解决方案的科学 医疗保健。在这项拟议的研究中，我们将评估两种推动干预措施，警报和同伴 比较反馈，它利用了构成理论基础的几个偏见 支持行为改变。 意义：心力衰竭的治疗缺口严重、昂贵，而且太普遍了(低采用率 SGLT2i和MRAS)。在退伍军人事务部，HF指导治疗的比率已经停滞不前。我们的 该组织和其他人报告说，使用最优方案可以避免34,000和21,000人死亡 SGLT2i和MRAS分别在美国实施 创新和影响：我们将测试多组件推动战略的有效性 (警示+同行比较)，这与单一组件策略相比很少进行。 文献中只有10%的临床指导的轻推干预措施是多组分的，并且 退伍军人事务部没有发现任何一种情况。这项研究将创造关于如何将这些结合在一起的知识 进一步推进该领域并有效地分配VA所需的不同战略 资源。这项研究的目标是HF治疗缺口(SGLT2和MRA)，其中没有先前的推动 研究已经证明了它的有效性。这项提议运用了一门实施科学 (CDS/PRISM)制定推动战略的方法，这是确保最佳方案所必需的 有效性、执行力和可持续性。 具体目标： 1)进行形成性评估，以制定两个推动策略，即信息警报和 同行比较反馈，鼓励临床医生开出MRA和SGLT2抑制剂。 2)使用RE-AIM框架评估两种推动策略的初步结果。 A)评估警报和同行比较战略的初步有效性 四组设计。 B)评估两个推动战略的执行结果。 I)我们将报告以下PRISM/RE-AIM结果：干预、接受者、 外部环境、基础设施、覆盖范围、采用和实施。 方法：这是一项单中心的先导性研究。对于目标1，我们将进行关键利益相关者 临床医生访谈和焦点小组，以评估SGLT2和MRA的障碍和促进者 开处方并提炼原型推进器。对于目标2，临床医生将被随机分成一组 四个方面：日常护理、信息提醒、同行比较反馈和 警觉和同行比较。我们将比较有效性，定义为新的处方 3个干预组与对照组相比，在30天内进行SGLT2或MRA。我们还将 报告其他结果，包括安全性、可及性、采用率和实施情况。 下一步/实施：我们将计划在更广泛的试验中测试推动策略 多个VAMC使用从本研究中获得的信息来为实施提供信息。我们会 与我们在国家心脏病学和PBM学术细节方面的合作伙伴合作，传播我们的 调查结果，并将在研究期间定期召开利益攸关方会议。