Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE)

Clinical decision support nudges, informed by social psychology and delivered via electronic health records (EHRs), are promising strategies to reduce the misuse of services in cases where optimal utilization may not be zero but should be well below current practice. These interventions seek to influence conscious and unconscious drivers of clinical decision making, are low cost to implement and disseminate, and can be incorporated into existing delivery systems. In the R21 phase of the proposed Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE) study, we will: select EHR-delivered nudges to address 3 topics of potential misuse in older adults based on the main psychological drivers of overuse identified in interviews with high-using clinicians; develop and pilot test decision support tools within a health systems’ EHR to understand technical feasibility, work flow fit, preliminary impact on clinical outcomes, and clinician acceptability; and develop and validate electronic clinical quality measures of potential overuse/misuse related to the care of older adults. In the R33 phase we will: refine these approaches and evaluate the effects of each nudge in a cluster randomized controlled trial conducted in over 40 clinical sites across a large geographic region. We will measure the impact on clinical quality measures, indicators of patient safety, and clinician attitudes.