@article{e8886e054e254e279cc2de14e123da0c,
title = "Design of Behavioral Economic Applications to Geriatrics Leveraging Electronic Health Records (BEAGLE): A pragmatic cluster randomized controlled trial",
abstract = "Background: Overtesting and treatment of older patients is common and may lead to harms. The Choosing Wisely campaign has provided recommendations to reduce overtesting and overtreatment of older adults. Behavioral economics-informed interventions embedded within the electronic health record (EHR) have been shown to reduce overuse in several areas. Our objective is to conduct a parallel arm, pragmatic cluster-randomized trial to evaluate the effectiveness of behavioral-economics-informed clinical decision support (CDS) interventions previously piloted in primary care clinics and designed to reduce overtesting and overtreatment in older adults. Methods/Design: This trial has two parallel arms: clinician education alone vs. clinician education plus behavioral-economics-informed CDS. There are three co-primary outcomes for this trial: (1) prostate-specific antigen (PSA) screening in older men, (2) urine testing for non-specific reasons in older women, and (3) overtreatment of diabetes in older adults. All eligible primary care clinics from a large regional health system were randomized using a modified constrained randomization process and their attributed clinicians were included. Clinicians were recruited to complete a survey and educational module. We randomized 60 primary care clinics with 374 primary care clinicians and achieved adequate balance between the study arms for prespecified constrained variables. Baseline annual overuse rates for the three co-primary outcomes were 25%, 23%, and 17% for the PSA, urine, and diabetes measures, respectively. Discussion: This trial is evaluating behavioral-economics-informed EHR-embedded interventions to reduce overuse of specific tests and treatments for older adults. The study will evaluate the effectiveness and safety of these interventions.",
keywords = "Behavioral economics, Diabetes mellitus, Electronic health records, Overuse, Prostate cancer screening, Urinary tract infections",
author = "Tiffany Brown and Rowe, {Theresa A.} and Lee, {Ji Young} and Petito, {Lucia C.} and Ryan Chmiel and Ciolino, {Jody D.} and Doctor, {Jason N.} and Fox, {Craig R.} and Goldstein, {Noah J.} and Darren Kaiser and Linder, {Jeffrey A.} and Daniella Meeker and Yaw Peprah and Persell, {Stephen D.}",
note = "Funding Information: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R33AG057383 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health . REDCap is supported at Feinberg School of Medicine by the Northwestern University Clinical and Translational Science (NUCATS) Institute . Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences , Grant Number UL1TR001422 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health in publications relating to this project. The NIH had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication. Funding Information: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R33AG057383. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. REDCap is supported at Feinberg School of Medicine by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health in publications relating to this project. The NIH had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2021",
year = "2022",
month = jan,
doi = "10.1016/j.cct.2021.106649",
language = "English (US)",
volume = "112",
journal = "Contemporary Clinical Trials",
issn = "1551-7144",
publisher = "Elsevier Inc.",
}
