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Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery
INTRODUCTION: Robust randomised trial data have shown that routine preoperative (pre-op) testing for cataract surgery patients is inappropriate. While guidelines have discouraged testing since 2002, cataract pre-op testing rates have remained unchanged since the 1990s. Given the challenges of reduci...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572383/ https://www.ncbi.nlm.nih.gov/pubmed/34732478 http://dx.doi.org/10.1136/bmjopen-2021-049568 |
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author | Ahmadi, Alast Sorensen, Andrea Villaflores, Chad Wes A Mafi, John N Vangala, Sitaram S Hofer, Ira S Bartlett, John D Cheng, Eric M Duval, Victor F Damberg, Cheryl Elashoff, David Goldstein, Noah J Ladapo, Joseph A Moore, James M Pessegueiro, Antonio M Shu, Suzanne B Skootsky, Samuel A Turner, Ashley Sarkisian, Catherine A |
author_facet | Ahmadi, Alast Sorensen, Andrea Villaflores, Chad Wes A Mafi, John N Vangala, Sitaram S Hofer, Ira S Bartlett, John D Cheng, Eric M Duval, Victor F Damberg, Cheryl Elashoff, David Goldstein, Noah J Ladapo, Joseph A Moore, James M Pessegueiro, Antonio M Shu, Suzanne B Skootsky, Samuel A Turner, Ashley Sarkisian, Catherine A |
author_sort | Ahmadi, Alast |
collection | PubMed |
description | INTRODUCTION: Robust randomised trial data have shown that routine preoperative (pre-op) testing for cataract surgery patients is inappropriate. While guidelines have discouraged testing since 2002, cataract pre-op testing rates have remained unchanged since the 1990s. Given the challenges of reducing low-value care despite strong consensus around the evidence, innovative approaches are needed to promote high-value care. This trial evaluates the impact of an interdisciplinary electronic health record (EHR) intervention that is informed by behavioural economic theory. METHODS AND ANALYSIS: This pragmatic randomised trial is being conducted at UCLA Health between June 2021 and June 2022 with a 12-month follow-up period. We are randomising all UCLA Health physicians who perform pre-op visits during the study period to one of the three nudge arms or usual care. These three nudge alerts address (1) patient harm, (2) increased out-of-pocket costs for patients and (3) psychological harm to the patients related to pre-op testing. The nudges are triggered when a physician starts to order a pre-op test. We hypothesise that receipt of a nudge will be associated with reduced pre-op testing. The primary outcome will be the change in the percentage of patients undergoing pre-op testing at 12 months. Secondary outcomes will include the percentage of patients undergoing specific categories of pre-op tests (labs, EKGs, chest X-rays (CXRs)), the efficacy of each nudge, same-day surgery cancellations and cost savings. ETHICS AND DISSEMINATION: The study protocol was approved by the institutional review board of the University of California, Los Angeles as well as a nominated Data Safety Monitoring Board. If successful, we will have created a tool that can be disseminated rapidly to EHR vendors across the nation to reduce inappropriate testing for the most common low-risk surgical procedures in the country. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT04104256. |
format | Online Article Text |
id | pubmed-8572383 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-85723832021-11-17 Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery Ahmadi, Alast Sorensen, Andrea Villaflores, Chad Wes A Mafi, John N Vangala, Sitaram S Hofer, Ira S Bartlett, John D Cheng, Eric M Duval, Victor F Damberg, Cheryl Elashoff, David Goldstein, Noah J Ladapo, Joseph A Moore, James M Pessegueiro, Antonio M Shu, Suzanne B Skootsky, Samuel A Turner, Ashley Sarkisian, Catherine A BMJ Open Health Services Research INTRODUCTION: Robust randomised trial data have shown that routine preoperative (pre-op) testing for cataract surgery patients is inappropriate. While guidelines have discouraged testing since 2002, cataract pre-op testing rates have remained unchanged since the 1990s. Given the challenges of reducing low-value care despite strong consensus around the evidence, innovative approaches are needed to promote high-value care. This trial evaluates the impact of an interdisciplinary electronic health record (EHR) intervention that is informed by behavioural economic theory. METHODS AND ANALYSIS: This pragmatic randomised trial is being conducted at UCLA Health between June 2021 and June 2022 with a 12-month follow-up period. We are randomising all UCLA Health physicians who perform pre-op visits during the study period to one of the three nudge arms or usual care. These three nudge alerts address (1) patient harm, (2) increased out-of-pocket costs for patients and (3) psychological harm to the patients related to pre-op testing. The nudges are triggered when a physician starts to order a pre-op test. We hypothesise that receipt of a nudge will be associated with reduced pre-op testing. The primary outcome will be the change in the percentage of patients undergoing pre-op testing at 12 months. Secondary outcomes will include the percentage of patients undergoing specific categories of pre-op tests (labs, EKGs, chest X-rays (CXRs)), the efficacy of each nudge, same-day surgery cancellations and cost savings. ETHICS AND DISSEMINATION: The study protocol was approved by the institutional review board of the University of California, Los Angeles as well as a nominated Data Safety Monitoring Board. If successful, we will have created a tool that can be disseminated rapidly to EHR vendors across the nation to reduce inappropriate testing for the most common low-risk surgical procedures in the country. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT04104256. BMJ Publishing Group 2021-11-03 /pmc/articles/PMC8572383/ /pubmed/34732478 http://dx.doi.org/10.1136/bmjopen-2021-049568 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Health Services Research Ahmadi, Alast Sorensen, Andrea Villaflores, Chad Wes A Mafi, John N Vangala, Sitaram S Hofer, Ira S Bartlett, John D Cheng, Eric M Duval, Victor F Damberg, Cheryl Elashoff, David Goldstein, Noah J Ladapo, Joseph A Moore, James M Pessegueiro, Antonio M Shu, Suzanne B Skootsky, Samuel A Turner, Ashley Sarkisian, Catherine A Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery |
title | Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery |
title_full | Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery |
title_fullStr | Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery |
title_full_unstemmed | Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery |
title_short | Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery |
title_sort | protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572383/ https://www.ncbi.nlm.nih.gov/pubmed/34732478 http://dx.doi.org/10.1136/bmjopen-2021-049568 |
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