Dataset Information

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.

SUBMITTER: Brown T

PROVIDER: S-EPMC8724916 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Design of Behavioral Economic Applications to Geriatrics Leveraging Electronic Health Records (BEAGLE): A pragmatic cluster randomized controlled trial.

Brown Tiffany T Rowe Theresa A TA Lee Ji Young JY Petito Lucia C LC Chmiel Ryan R Ciolino Jody D JD Doctor Jason N JN Fox Craig R CR Goldstein Noah J NJ Kaiser Darren D Linder Jeffrey A JA Meeker Daniella D Peprah Yaw Y Persell Stephen D SD

Contemporary clinical trials 20211208

<h4>Background</h4>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 ...[more]

PMID: 34896294

Similar Datasets

Project description:BackgroundIdentifying patients at a high risk of psychosis relapse is crucial for early interventions. A relevant psychiatric clinical context is often recorded in clinical notes; however, the utilization of unstructured data remains limited. This study aimed to develop psychosis-relapse prediction models using various types of clinical notes and structured data.MethodsClinical data were extracted from the electronic health records of the Ajou University Medical Center in South Korea. The study population included patients with psychotic disorders, and outcome was psychosis relapse within 1 year. Using only structured data, we developed an initial prediction model, then three natural language processing (NLP)-enriched models using three types of clinical notes (psychological tests, admission notes, and initial nursing assessment) and one complete model. Latent Dirichlet Allocation was used to cluster the clinical context into similar topics. All models applied the least absolute shrinkage and selection operator logistic regression algorithm. We also performed an external validation using another hospital database.ResultsA total of 330 patients were included, and 62 (18.8%) experienced psychosis relapse. Six predictors were used in the initial model and 10 additional topics from Latent Dirichlet Allocation processing were added in the enriched models. The model derived from all notes showed the highest value of the area under the receiver operating characteristic (AUROC = 0.946) in the internal validation, followed by models based on the psychological test notes, admission notes, initial nursing assessments, and structured data only (0.902, 0.855, 0.798, and 0.784, respectively). The external validation was performed using only the initial nursing assessment note, and the AUROC was 0.616.ConclusionsWe developed prediction models for psychosis relapse using the NLP-enrichment method. Models using clinical notes were more effective than models using only structured data, suggesting the importance of unstructured data in psychosis prediction.

Dataset Information

Design of Behavioral Economic Applications to Geriatrics Leveraging Electronic Health Records (BEAGLE): A pragmatic cluster randomized controlled trial.

Background

Methods/design

Discussion

Publications

Design of Behavioral Economic Applications to Geriatrics Leveraging Electronic Health Records (BEAGLE): A pragmatic cluster randomized controlled trial.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets