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

项目总结/摘要 心血管疾病（CVD）是美国发病率和死亡率的主要原因。有力证据 表明他汀类药物可以降低CVD的风险。对于现有CVD患者，他汀类药物已被证明 降低死亡率。尽管有这一证据，他汀类药物的处方不足，这有助于心血管疾病的差异， 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- 从而实现更高价值的护理。行为经济学家利用心理学和人类行为的见解， 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 “轻推，包括改变默认选项，使最佳选择容易，使用积极的选择框架， 促使决策发生在现在，而不是推到未来，并战略性地制定信息， 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，在医疗保健环境中系统地采用和验证， 有限公司2016年，我们的团队成立了Penn Medicine Nudge Unit，这是医疗保健环境中的首个此类举措 它汇集了一个多学科团队，专注于设计、测试和扩展电子健康记录中的轻推使用 以改善宾夕法尼亚大学卫生系统的医疗保健服务。 在这项研究中，我们将测试在EHR中使用轻推的可行性和有效性， 他汀类药物被处方给国家实践指南指示应该使用他汀类药物的患者。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， 医生审查并决定他们的病人名单上有资格接受他汀类药物治疗。我们将进行一次- 一项为期一年的、务实的三臂随机分组试验，比较了有无主动选择干预的效果。 每月向控制组反馈社会比较。我们将评估干预措施是否减少了护理方面的差距 基于社会人口特征及其对LDL水平的影响。

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.