EHR nudges: Development and testing of a behavioral economics electronic health record module

项目摘要 本研究旨在利用行为经济学与电子健康记录技术的力量， 为老年人提供适当的糖尿病护理。尽管作出了各种努力，但不适当的照顾仍然存在。 ABIM基金会的明智选择运动确定了需要改进的重点领域;十个之一 选择明智的举措选择美国老年医学会促进积极血糖 目标和有限的药物治疗老年糖尿病患者。改变提供者的行为， 然而，这是具有挑战性的，现有的基于信息的方法不足。行为学中的新概念 经济学，一个融合了经济学和心理学的见解，认识到人类 可预测的决策错误，已经在各种医疗保健环境中显示出希望。结合这种 电子健康记录（EHR）中的方法将允许无缝集成到临床工作流程中， 最小的额外认知负担，并提供一种广泛扩展有效的 干预措施。我们建议开发一个基于行为经济学的EHR模块，以促进适当的 老年糖尿病患者的临床护理。具体目标包括：1）开发可扩展的EHR定制 利用行为经济学见解（BE-EHR模块）促进适当糖尿病护理的工具包 根据美国老年学会的明智选择指南。我们将合理安排 以用户为中心的设计过程，将行为经济学方法纳入现有的临床决策 支持工具和临床工作流程，以设计、迭代改进和可用性测试新模块。2)试点 测试新的BE-EHR模块的可行性和可接受性，并生成临床医生的初步估计 遵循明智选择准则。我们将对BE进行为期6个月的单臂试点研究- 在4个门诊初级保健和/或老年病诊所采用电子健康记录模块，以衡量利用率和可行性， 估计其对提供适当护理的影响。3)测试BE-EHR模块减少 老年人不适当的糖尿病治疗我们将进行为期18个月的，严谨，务实， 在纽约大学Langone医学中心门诊网络内的70个地点进行的随机分组对照试验， 确定BE-EHR模块对老年人适当糖尿病护理的影响。这项建议 结合了一个独特的，经验丰富的多学科团队与突破性的方法，以改善护理 美国老年糖尿病患者

Project Summary This study aims to leverage the power of behavioral economics with electronic health record technology to promote appropriate diabetes care for older adults. Despite a variety of efforts, inappropriate care persists. The ABIM Foundation’s Choosing Wisely Campaign identifies focus areas for improvement; one of ten Choosing Wisely initiatives chosen by the American Geriatrics Society promotes less aggressive glycemic targets and limited pharmacologic therapy for older adults with diabetes. Changing provider behavior, however, is challenging, and existing information-based approaches fall short. Novel concepts from behavioral economics, a field that blends insights from economics and psychology to recognize that humans make predictable decision errors, have shown promise in a variety of healthcare settings. Incorporating such approaches within the electronic health record (EHR) will allow seamless integration into clinical workflow with minimal additional cognitive burden, and provide a mechanism for widespread scaling of effective interventions. We propose to develop a behavioral economics-based EHR module to promote appropriate clinical care of older adults with diabetes. Specific aims include: 1) To develop a scalable, EHR customization toolkit that leverages behavioral economic insights (the BE-EHR module) to promote appropriate diabetes care in older adults based on the American Geriatric Society’s Choosing Wisely guideline. We will implement a user-centered design process to incorporate behavioral economic approaches into existing clinical decision support tools and clinical workflows to design, iteratively refine, and usability test the new module. 2) To pilot test the new BE-EHR module’s feasibility and acceptability and generate preliminary estimates of clinician compliance with the Choosing Wisely guideline. We will conduct a 6-month, single-arm pilot study of the BE- EHR module in 4 outpatient primary care and/or geriatrics clinics to measure utilization and feasibility, and to estimate its impact on appropriate care delivery. 3) To test the ability of the BE-EHR module to reduce inappropriate diabetes treatment among older adults. We will conduct an 18-month, rigorous, pragmatic, cluster-randomized, controlled trial in 70 sites within the NYU Langone Medical Center ambulatory network to determine the BE-EHR module’s impact on appropriate diabetes care among older adults. This proposal combines a unique, experienced multi-disciplinary team with a ground-breaking approach to improve the care of older Americans with diabetes.