Abstract
Background: Unnecessary testing and treatment of common conditions in older adults can lead to significant morbidity and mortality. The primary objective of this study was to develop and pilot test a set of clinical decision support (CDS) alerts informed by social psychology to address overuse in three areas related to ambulatory care of older adults. Methods: We developed three electronic health record (EHR) CDS alerts to address overuse and pilot tested them from January 17, 2019 to July 17, 2019. We enrolled 14 primary care physicians from three practices within a large health system who cared for adults aged 65 years and older. Three measures of overuse applied to patients meeting the following criteria: ordering of prostate-specific antigen (PSA) for prostate cancer screening in adult men aged 76 years and older, ordering of urinalysis or urine cultures (UA or UC) for non-specific reasons to identify bacteriuria in women aged 65 years and older, and overtreatment of diabetes with insulin or oral hypoglycemic medications in adults aged at 75 years and older (DM). Clinicians received CDS alerts when criteria for any of the three overuse measures were met. We then surveyed clinicians to evaluate their experience with the CDS alerts. Results: The number of clinical encounters that triggered CDS alerts was 19 for PSA, 48 for UA/UC and 128 for DM. For PSA encounters, 4 (21%) orders were not performed after the alert. In the UA/UC encounters 29 (60%) orders were not performed after the alert. For the DM encounters, 21 (34%) had diabetes therapy reduced following the alert. Survey respondents indicated that the alerts were clinically accurate and sometimes led them to change their clinical action. Conclusions: These CDS alerts were feasible to implement and may minimize unnecessary testing and treatment of common conditions in older adults.
| Original language | English (US) |
|---|---|
| Article number | 104794 |
| Journal | Archives of Gerontology and Geriatrics |
| Volume | 104 |
| DOIs | |
| State | Published - Jan 1 2023 |
Funding
The study was funded by grant R21AG057383 and grant R33AG057383 from the National Institute on Aging , National Institutes of Health (NIH) . 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 . Dr. Linder is also supported by grant P30AG059988 from the National Institute on Aging . 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. Dr. Persell receives research support from Omron Healthcare and previously received research support from Pfizer, Inc. He is a consultant QuiO Technologies and the RAND Corporation. After the completion of the research presented in this paper, Dr. Friedberg became a paid employee of Blue Cross Blue Shield of Massachusetts.
Keywords
- Behavioral economics
- Diabetes mellitus
- Electronic health records
- Overuse
- Prostate cancer screening
- Urinary tract infections
ASJC Scopus subject areas
- Health(social science)
- Aging
- Gerontology
- Geriatrics and Gerontology
