TY - JOUR
T1 - Nudging Physician Prescription Decisions by Partitioning the Order Set
T2 - Results of a Vignette-Based Study
AU - Tannenbaum, David
AU - Doctor, Jason N.
AU - Persell, Stephen D.
AU - Friedberg, Mark W.
AU - Meeker, Daniella
AU - Friesema, Elisha M.
AU - Goldstein, Noah J.
AU - Linder, Jeffrey A.
AU - Fox, Craig R.
N1 - Funding Information:
This research was supported by a grant from the National Institutes of Health/National Institute on Aging (Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections, PI J Doctor, Grant#: RC4 AG039115).
Funding Information:
JND and DM are employed by the University of Southern California, who received the aforementioned grant from the National Institute on Aging, which provided support for this research. Work on this research by DM and MWF was supported by a subcontract to RAND from the University of Southern California as part of the aforementioned grant. Work on this research by DT, CRF, and NJG was supported by a subcontract to UCLA from the University of Southern California as part of the aforementioned grant. Work on this research by SDP and EMF was supported by a subcontract to Northwestern University from the University of Southern California as part of the aforementioned grant. Work on this research by JAL was supported by a subcontract to Brigham and Women’s Hospital as part of the aforementioned grant.
Publisher Copyright:
© 2014, Society of General Internal Medicine.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background: Healthcare professionals are rapidly adopting electronic health records (EHRs). Within EHRs, seemingly innocuous menu design configurations can influence provider decisions for better or worse. Objective: The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. Participants: We surveyed 166 primary care providers in a research network of practices in the greater Chicago area, of whom 84 responded (51 % response rate). Respondents and non-respondents were similar on all observable dimensions except that respondents were more likely to work in an academic setting. Design: The questionnaire consisted of seven clinical vignettes. Each vignette described typical signs and symptoms for acute respiratory infections, and providers chose treatments from a menu of options. For each vignette, providers were randomly assigned to one of two menu partitions. For antibiotic-inappropriate vignettes, the treatment menu either listed over-the-counter (OTC) medications individually while grouping prescriptions together, or displayed the reverse partition. For antibiotic-appropriate vignettes, the treatment menu either listed narrow-spectrum antibiotics individually while grouping broad-spectrum antibiotics, or displayed the reverse partition. Main Measures: The main outcome was provider treatment choice. For antibiotic-inappropriate vignettes, we categorized responses as prescription drugs or OTC-only options. For antibiotic-appropriate vignettes, we categorized responses as broad- or narrow-spectrum antibiotics. Key Results: Across vignettes, there was an 11.5 percentage point reduction in choosing aggressive treatment options (e.g., broad-spectrum antibiotics) when aggressive options were grouped compared to when those same options were listed individually (95 % CI: 2.9 to 20.1 %; p =.008). Conclusions: Provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise. The careful crafting of EHR order sets can serve as an important opportunity to improve patient care without constraining physicians’ ability to prescribe what they believe is best for their patients.
AB - Background: Healthcare professionals are rapidly adopting electronic health records (EHRs). Within EHRs, seemingly innocuous menu design configurations can influence provider decisions for better or worse. Objective: The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. Participants: We surveyed 166 primary care providers in a research network of practices in the greater Chicago area, of whom 84 responded (51 % response rate). Respondents and non-respondents were similar on all observable dimensions except that respondents were more likely to work in an academic setting. Design: The questionnaire consisted of seven clinical vignettes. Each vignette described typical signs and symptoms for acute respiratory infections, and providers chose treatments from a menu of options. For each vignette, providers were randomly assigned to one of two menu partitions. For antibiotic-inappropriate vignettes, the treatment menu either listed over-the-counter (OTC) medications individually while grouping prescriptions together, or displayed the reverse partition. For antibiotic-appropriate vignettes, the treatment menu either listed narrow-spectrum antibiotics individually while grouping broad-spectrum antibiotics, or displayed the reverse partition. Main Measures: The main outcome was provider treatment choice. For antibiotic-inappropriate vignettes, we categorized responses as prescription drugs or OTC-only options. For antibiotic-appropriate vignettes, we categorized responses as broad- or narrow-spectrum antibiotics. Key Results: Across vignettes, there was an 11.5 percentage point reduction in choosing aggressive treatment options (e.g., broad-spectrum antibiotics) when aggressive options were grouped compared to when those same options were listed individually (95 % CI: 2.9 to 20.1 %; p =.008). Conclusions: Provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise. The careful crafting of EHR order sets can serve as an important opportunity to improve patient care without constraining physicians’ ability to prescribe what they believe is best for their patients.
KW - Behavioral science
KW - Electronic health records
KW - Medical decision-making
KW - Physician decision support
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U2 - 10.1007/s11606-014-3051-2
DO - 10.1007/s11606-014-3051-2
M3 - Article
C2 - 25394536
AN - SCOPUS:84940005833
VL - 30
SP - 298
EP - 304
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 3
ER -