Leveraging the Electronic Health Record to Nudge Clinicians to Prescribe Evidence-Based Statin Medications to Reduce the Risk of Cardiovascular Disease

利用电子健康记录促使临床医生开出基于证据的他汀类药物以降低心血管疾病的风险

• 批准号: 10004759
• 负责人: Mitesh S. Patel
• 金额: $ 65.64万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10004759
• 关键词: Address; Adherence; Adoption; Architecture; Behavior; Behavioral; Cardiovascular Diseases; Cardiovascular system; Caring; Characteristics; Cluster randomized trial; Control Groups; Data; Decision Making; Effectiveness; Electronic Health Record; Environment; Ethnic Origin; Feedback; Future; Goals; Health system; Healthcare; Healthcare Systems; Household; Human; Income; Industry; Information Technology; Insurance; Intervention; Lead; Leadership; Low-Density Lipoproteins; Medical; Medicine; Morbidity - disease rate; Patients; Pennsylvania; Performance; Pharmaceutical Preparations; Physicians; Practice Guidelines; Primary Care Physician; Psychology; Race; Randomized Controlled Trials; Resistance; Screening for cancer; Secondary to; Socioeconomic Factors; Testing; United States; Universities; Use Effectiveness; Validation; arm; base; behavior change; behavior influence; behavioral economics; cardiovascular disorder risk; clinical care; cost; design; digital; disparity reduction; end of life care; evidence base; evidence based guidelines; health care delivery; health care disparity; health care settings; improved; income insurance; insight; mortality; multidisciplinary; social; sociodemographics; socioeconomic disparity

PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Strong evidence indicates that statin medications can reduce the risk of CVD. For patients with existing CVD, statins have been shown to reduce mortality. Despite this evidence, statins are under-prescribed and this contributes to disparities in cardiovascular care that exist based on sociodemographic factors such as race/ethnicity, income, and insurance. The growing adoption of the electronic health record (EHR) brings new opportunities to improve clinician decision- making toward higher-value care. Behavioral economists have used insights from psychology and human behavior to modify choice architecture to influence decision-making without restricting choice. These approaches, often termed as “nudges, include changing defaults options to make the optimal choice the easy one, using active choice framing to prompt decision-making to occur now rather than be pushed off into the future, and strategically framing information such as social comparison feedback to use social influences and norms to encourage behavior change. While these approaches are commonly used throughout other industries, systematic adoption and validation within health care settings has been limited. In 2016, our group formed the Penn Medicine Nudge Unit, a first-of-its-kind initiative within a health care setting that brings together a multidisciplinary team focused on designing, testing, and scaling the use of nudges within the EHR to improve health care delivery at the University of Pennsylvania Health System. In this study, we will test the feasibility and effectiveness of using nudges within the EHR to increase the rate at which statin medications are prescribed to patients for whom national practice guidelines indicate should be on statins. We will demonstrate the feasibility of integrating an active choice intervention in the electronic health record that prompts physicians to review and make decisions on a list of their patients eligible for statin therapy. We will then conduct a one- year, pragmatic three-arm cluster randomized trial to compare the effect of the active choice intervention with and without monthly social comparisons feedback to a control group. We will evaluate if the interventions reduce disparities in care based on sociodemographic characteristics and its impact on LDL levels.

项目概要/摘要 心血管疾病（CVD）是美国发病率和死亡率的主要原因。有力的证据 表明他汀类药物可以降低心血管疾病的风险。对于患有 CVD 的患者，他汀类药物已被证明可以 降低死亡率。尽管有这些证据，但他汀类药物的处方量仍然不足，这导致了心血管疾病的差异 基于种族/民族、收入和保险等社会人口因素而存在的护理。 电子健康记录 (EHR) 的日益普及为改善临床医生的决策带来了新的机会 迈向更高价值的护理。行为经济学家利用心理学和人类行为的见解来 修改选择架构以影响决策而不限制选择。这些方法通常被称为 “推动，包括更改默认选项，使最佳选择变得容易，使用主动选择框架 立即做出决策，而不是推迟到未来，并战略性地构建信息，例如 作为社会比较反馈，利用社会影响和规范来鼓励行为改变。虽然这些方法 在其他行业中普遍使用，在医疗保健机构中的系统采用和验证已经 有限的。 2016 年，我们小组成立了宾夕法尼亚大学医学助推小组 (Penn Medicine Nudge Unit)，这是医疗保健机构内的首个此类举措 汇集了一个多学科团队，专注于设计、测试和扩展 EHR 中助推的使用 改善宾夕法尼亚大学医疗系统的医疗保健服务。 在这项研究中，我们将测试在电子病历中使用助推来提高患者接受率的可行性和有效性。 他汀类药物是为国家实践指南指示应使用他汀类药物的患者开出的。我们将 证明在电子健康记录中整合主动选择干预的可行性，以提示 医生对符合他汀类药物治疗资格的患者名单进行审查并做出决定。然后我们将进行一次—— 年，实用三臂整群随机试验，比较主动选择干预和不干预的效果 每月向对照组反馈社会比较。我们将评估干预措施是否减少护理差异 基于社会人口特征及其对低密度脂蛋白水平的影响。