I-SCREEN: Increasing Screening for Cancer using a Randomized Evaluation of EHR-based Nudges

项目摘要 癌症仍然是美国老年人死亡的主要原因。然而，尽管 建立了支持适当癌症筛查的指导方针，以防止死亡和不良癌症- 与结果相关，筛查往往得不到充分利用。适当筛查的障碍甚至更大 面临长期筛查差距的群体，如种族/族裔少数群体和低收入者 社会经济地位(SES)。筛查未充分利用的关键驱动因素是面临的决策偏差 临床医生和患者，强调需要可扩展的解决方案来解决这些偏见 并为克服高危患者面临的障碍而量身定做。 轻推，即利用行为经济学原理设计的干预措施，通过解决 导致次优决策的偏见。我们的团队在卫生系统方面拥有丰富的经验 测试和扩展轻推干预措施，以克服患者和/或临床医生面临的决策偏见。我们 还展示了这些类型的轻推如何可以改善医疗保健价值和患者结果。 由于电子健康记录(EHR)已被美国90%以上的临床医生采用，它是一种 部署大规模行为改变推动干预的理想平台。 在这项研究中，我们建议对临床医生和患者进行个性化的轻推干预，重点是如何 针对高危患者的需求量身定做轻推，以及如何实施前景看好的轻推来改善癌症 在老年人中进行筛查。我们将在宾夕法尼亚医学院试行这项工作，然后在 宾夕法尼亚大学医学院、大学医院和萨特卫生系统的网站。 在R61阶段，我们将完成宾夕法尼亚大学医学院的以下目标：分析EHR和索赔数据，并 确定未完成癌症筛查的高危患者的特征和亚组(目标1)，测试 在EHR轻推工具包中进行个别轻推干预的可行性(目标2)，以及试点测试轻推 确定最有希望提高高危人群癌症筛查率的干预措施 各亚组患者(目标3)。 在R33阶段，我们将在宾夕法尼亚大学医学院、大学医院和萨特实现以下目标 健康：进行两臂务实的整群随机对照试验，以测试 向临床医生和患者提供基于电子病历的个性化提示，以提高癌症筛查率(目标1)， 评估基于EHR的轻推干预措施是否降低了种族/民族癌症筛查率的差异 少数民族和社会经济地位低的患者(目标2)，并为未来定制的电子病历设计提供信息 通过检查临床医生和患者治疗反应的异质性进行干预 特点(目标3)。

Project Summary Cancer remains a leading cause of mortality among older adults in the United States. However, despite established guidelines supporting appropriate cancer screening in order to prevent death and adverse cancer- related outcomes, screening is often underutilized. Barriers to appropriate screening are even greater for groups facing long-standing screening disparities, such as racial/ethnic minorities and individuals with low socioeconomic status (SES). Key drivers of screening underutilization are decision-making biases facing clinicians and patients, highlighting the need for scalable solutions that are designed to address these biases and tailored to overcome barriers facing high-risk patients. Nudges, interventions designed using behavioral economic principles, improve behavior by addressing biases that lead to suboptimal decisions. Our team has extensive experience working with health systems to test and scale nudge interventions to overcome decision-making biases facing patients and/or clinicians. We have also demonstrated how these types of nudges can improve health care value and patient outcomes. Since electronic health records (EHRs) have been adopted by more than 90% of clinicians in the US, it is an ideal platform upon which to deploy large scale behavior change nudge interventions. In this study, we propose to personalize nudge interventions to clinicians and patients, with a focus on how to tailor nudges to the needs of high-risk patients and how to implement promising nudges to improve cancer screening among older adults. We will pilot this work at Penn Medicine and then implement a pragmatic trial at sites in the Penn Medicine, University Hospitals, and Sutter Health systems. In the R61 phase, we will complete the following aims at Penn Medicine: analyze EHR and claims data and identify characteristics and subgroups of patients at high-risk for not completing cancer screening (Aim 1), test the feasibility of individual nudge interventions within an EHR nudge toolkit (Aim 2), and pilot test nudge interventions to identify the most promising approaches to increase cancer screening rates for high-risk patients in each subgroup (Aim 3). In the R33 phase, we will achieve the following aims at Penn Medicine, University Hospitals, and Sutter Health: conduct a two-arm pragmatic cluster-randomized controlled trial to test the effectiveness of personalized EHR-based nudges to clinicians and patients on increasing cancer screening rates (Aim 1), evaluate if EHR-based nudge interventions reduce disparities in cancer screening rates for racial/ethnic minorities and patients with low socioeconomic status (Aim 2), and inform future design of tailored EHR interventions by examining heterogeneity of treatment response with respect to clinician and patient characteristics (Aim 3).