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| ID | Type | Description | Link |
|---|---|---|---|
| R33AG057383 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| University of Southern California | OTHER |
| University of California, Los Angeles | OTHER |
| National Institute on Aging (NIA) | NIH |
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Investigators will evaluate clinical decision support nudges informed by behavioral science and directed at primary care clinicians. These will be used to reduce commonly misused, and potentially harmful, diagnostic and therapeutic actions that occur in the care of older adults (e.g. overtreatment of type 2 diabetes, misuse of PSA screening, misuse of urine testing in women with nonspecific symptoms or no symptoms.
Diagnostic and therapeutic strategies misapplied to older adults can lead to increased morbidity and mortality. Despite recommendations from the American Geriatrics Society for the Choosing Wisely Initiative, there are clear examples where clinicians do not often follow best practices leading to patient harm. These include: (1) testing and treatment for asymptomatic bacteriuria (ASB) in older women, (2) prostate specific antigen (PSA) screening in older men, and (3) aggressive treatment with insulin or oral hypoglycemics for type 2 diabetes.
Clinical decision support nudges, informed by behavioral economics and social psychology and delivered via electronic health records (EHRs), are promising strategies to reduce the misuse of services. Behavioral economics-informed interventions influence conscious and unconscious drivers of decision making, are low cost, and can be incorporated into existing systems.
This randomized controlled trial will evaluate the effects of three clinical decision support nudges on three clinical quality measures, indicators of patient safety, and clinician attitudes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Brief clinician education | Active Comparator | Clinicians attributed to clinics in the brief clinician education arm will receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. |
|
| Clinical decision support nudges and brief clinician education | Experimental | Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EHR clinical decision support nudges | Behavioral | Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria. |
|
| Measure | Description | Time Frame |
|---|---|---|
| PSA Screening in Older Men | Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | 18 months |
| Urine Testing for Non-specific Reasons | Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | 18 months |
| Diabetes Overtreatment in the Elderly | Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | 18 months |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of UTI Requiring Hospital Care Among Women 65 and Over Following Clinical Decision Support Exposure | Emergency department visit or hospitalization for an infection originating from the urinary tract within 28 days of any primary care office visit with decision support exposure. | 18 months |
| Rate of UTI Requiring Hospital Care Among Women 65 and Over Following an Office Visit |
| Measure | Description | Time Frame |
|---|---|---|
| PSA Screening in Older Men | Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | 19-30 months |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Stephen D. Persell, MD, MPH | Northwestern University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Northwestern Medicine | Chicago | Illinois | 60611 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41672386 | Derived | Duong N, Lee JY, Peprah Y, Brown T, Linder JA, Doctor JN, Meeker D, Fox CR, Goldstein NJ, Persell SD, Petito LC. Changing Clinician Behavior in Geriatrics: Point-of-Care Alerts for Prostate-Specific Antigen Screening. Am J Prev Med. 2026 Feb 10;71(1):108305. doi: 10.1016/j.amepre.2026.108305. Online ahead of print. | |
| 38315997 | Derived | Persell SD, Petito LC, Lee JY, Meeker D, Doctor JN, Goldstein NJ, Fox CR, Rowe TA, Linder JA, Chmiel R, Peprah YA, Brown T. Reducing Care Overuse in Older Patients Using Professional Norms and Accountability : A Cluster Randomized Controlled Trial. Ann Intern Med. 2024 Mar;177(3):324-334. doi: 10.7326/M23-2183. Epub 2024 Feb 6. |
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Individual participant data will not be shared.
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| ID | Title | Description |
|---|---|---|
| FG000 | Brief Clinician Education | Clinicians attributed to clinics in the brief clinician education arm will receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. Brief clinician education: Clinicians will be invited to view brief education material. |
| FG001 | Clinical Decision Support Nudges and Brief Clinician Education | Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. EHR clinical decision support nudges: Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria. Brief clinician education: Clinicians will be invited to view brief education material. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Brief Clinician Education | Clinicians attributed to clinics in the brief clinician education arm will receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. Brief clinician education: Clinicians will be invited to view brief education material. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | PSA Screening in Older Men | Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | Posted | Count of Participants | Participants | 18 months |
|
These adverse event data were collected over 18-month trial intervention period.
All adverse event outcomes were systematically queried for using electronic health record data.
Each adverse event is for a specific, separate clinical outcome. The denominators of patients 'at risk' differ by adverse event. For example, male patients who were included in denominator for diabetes outcomes are not 'at risk' for interventions or outcome denominators aimed at urine studies for female patients.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Brief Clinician Education | Clinicians attributed to clinics in the brief clinician education arm will receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. Brief clinician education: Clinicians will be invited to view brief education material. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| EHR-identified ED or hospital care possibly due to UTI or sepsis | Renal and urinary disorders | Systematic Assessment | EHR-identified ED or hospital care possibly due to UTI or sepsis among women 65 and over following an office visit. Adverse event were assessed for the specific population of subjects to which this measure applies. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Poor diabetes control | General disorders | Systematic Assessment | Poor diabetes control among previously tightly controlled. Adverse event were assessed for the specific population of subjects to which this measure applies. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Stephen D. Persell, MD, MPH, FACP | Northwestern University | 3125036464 | spersell@nm.org |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 1, 2023 | Jun 1, 2023 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D003924 | Diabetes Mellitus, Type 2 |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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Cluster-randomized by primary care clinic using a constrained randomization process.
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| Brief clinician education | Behavioral | Clinicians will be invited to view brief education material. |
|
Emergency department visit or hospitalization for an infection originating from the urinary tract within 28 days of any primary care office visit |
| 18 months |
| Rate of Hyperglycemia Requiring Hospital Care Following Clinical Decision Support Exposure | Emergency department visit or hospitalization for hyperglycemia within 90 days of an index visit where the clinician was exposed to the diabetes decision support. | 18 months |
| Rate of Hyperglycemia Requiring Hospital Care Among Previously Tightly Controlled | Emergency department visit or hospitalization for hyperglycemia among patients who previously had a HbA1c <7.0 and met the criteria for treatment deintensification intervention and had one or more outpatient primary care encounters during the study period. | 18 months |
| Rate of Poor Diabetes Control Among Previously Tightly Controlled | Occurrence of HbA1c >9.0 among patients who previously had a HbA1c <7.0 and met the criteria for treatment deintensification intervention and had one or more outpatient primary care encounters during the study period. | 18 months |
| Rate of Hypoglycemia Requiring Urgent Care Among Previously Tightly Controlled | Emergency department visit or hospitalization for hypoglycemia among patients who previously had a HbA1c <7.0 and met the criteria for treatment deintensification intervention and had one or more outpatient primary care encounters during the study period | 18 months |
| Urine Testing for Non-specific Reasons | Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | 19-30 months |
| Diabetes Overtreatment in the Elderly | Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | 19-30 months |
| Rates of Prostate Biopsy | Rate of prostate biopsy among men >=76 with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer at the beginning of the measurement period | 18 months and 19-30 months |
| Rate of Prostate MRI | Rate of prostate MRI among men >=76 with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer at the beginning of the measurement period | 18 months and 19-30 months |
| Rate of Prostate Cancer Diagnosis | Rate of prostate cancer diagnosis among men >=76 with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer at the beginning of the measurement period | 18 months and 19-30 months |
| PSA Screening Done by Non PCP in Men Over 76 Years Old | Presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period ordered by a non-primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | 18 months and 19-30 months |
| PSA Screening in Men Aged 55 to 69 and Age 70 to 75 | Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period for men aged 55-69 and men aged 70-75 who are without a diagnosis suggesting a history of prostate cancer | 18 months and 19-30 months |
| Rates of Urinalysis and Urine Culture Use in Women 65 and Older | Proportion of all women with one or more visit to an eligible clinic during the prior 12 months receiving urinalysis and/or urine culture | 18 months and 19-30 months |
| Rate of Treatment for Antibiotics for UTI in Women 65 and Older | Proportion of all women with one or more encounter to an eligible clinic during the prior 12 months receiving an antibiotic for confirmed or possible UTI. | 18 months and 19-30 months |
| Dose Reduction in Insulin, Sulfonylurea or Meglitinides | Proportion of patients 75 years old and older with initial HbA1c <7.0 and treated with insulin, sulfonylurea or meglitinides who have a dose reduction | 18 months, 24 months |
| PSA Screening in Older Men by Race | NIH-required analysis. Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | 18 months |
| PSA Screening in Older Men by Ethnicity | NIH-required analysis. Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | 18 months |
| Urine Testing for Non-specific Reasons by Race | NIH-required analysis. Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | 18 months |
| Urine Testing for Non-specific Reasons by Ethnicity | NIH-required analysis. Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | 18 months |
| Diabetes Overtreatment in the Elderly by Sex | NIH-required analysis. Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | 18 months |
| Diabetes Overtreatment in the Elderly by Race | NIH-required analysis. Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | 18 months |
| Diabetes Overtreatment in the Elderly by Ethnicity | NIH-required analysis. Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | 18 months |
| Clinical Decision Support Nudges and Brief Clinician Education |
Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. EHR clinical decision support nudges: Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria. Brief clinician education: Clinicians will be invited to view brief education material. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. EHR clinical decision support nudges: Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria. Brief clinician education: Clinicians will be invited to view brief education material. |
|
|
|
| Primary | Urine Testing for Non-specific Reasons | Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | Posted | Count of Participants | Participants | 18 months |
|
|
|
|
| Primary | Diabetes Overtreatment in the Elderly | Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | Posted | Count of Participants | Participants | 18 months |
|
|
|
|
| Secondary | Rate of UTI Requiring Hospital Care Among Women 65 and Over Following Clinical Decision Support Exposure | Emergency department visit or hospitalization for an infection originating from the urinary tract within 28 days of any primary care office visit with decision support exposure. | Not Posted | 18 months | Participants |
| Secondary | Rate of UTI Requiring Hospital Care Among Women 65 and Over Following an Office Visit | Emergency department visit or hospitalization for an infection originating from the urinary tract within 28 days of any primary care office visit | Not Posted | 18 months | Participants |
| Secondary | Rate of Hyperglycemia Requiring Hospital Care Following Clinical Decision Support Exposure | Emergency department visit or hospitalization for hyperglycemia within 90 days of an index visit where the clinician was exposed to the diabetes decision support. | Not Posted | 18 months | Participants |
| Secondary | Rate of Hyperglycemia Requiring Hospital Care Among Previously Tightly Controlled | Emergency department visit or hospitalization for hyperglycemia among patients who previously had a HbA1c <7.0 and met the criteria for treatment deintensification intervention and had one or more outpatient primary care encounters during the study period. | Not Posted | 18 months | Participants |
| Secondary | Rate of Poor Diabetes Control Among Previously Tightly Controlled | Occurrence of HbA1c >9.0 among patients who previously had a HbA1c <7.0 and met the criteria for treatment deintensification intervention and had one or more outpatient primary care encounters during the study period. | Not Posted | 18 months | Participants |
| Secondary | Rate of Hypoglycemia Requiring Urgent Care Among Previously Tightly Controlled | Emergency department visit or hospitalization for hypoglycemia among patients who previously had a HbA1c <7.0 and met the criteria for treatment deintensification intervention and had one or more outpatient primary care encounters during the study period | Not Posted | 18 months | Participants |
| Other Pre-specified | PSA Screening in Older Men | Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | Not Posted | 19-30 months | Participants |
| Other Pre-specified | Urine Testing for Non-specific Reasons | Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | Not Posted | 19-30 months | Participants |
| Other Pre-specified | Diabetes Overtreatment in the Elderly | Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | Not Posted | 19-30 months | Participants |
| Other Pre-specified | Rates of Prostate Biopsy | Rate of prostate biopsy among men >=76 with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer at the beginning of the measurement period | Not Posted | 18 months and 19-30 months | Participants |
| Other Pre-specified | Rate of Prostate MRI | Rate of prostate MRI among men >=76 with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer at the beginning of the measurement period | Not Posted | 18 months and 19-30 months | Participants |
| Other Pre-specified | Rate of Prostate Cancer Diagnosis | Rate of prostate cancer diagnosis among men >=76 with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer at the beginning of the measurement period | Not Posted | 18 months and 19-30 months | Participants |
| Other Pre-specified | PSA Screening Done by Non PCP in Men Over 76 Years Old | Presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period ordered by a non-primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | Not Posted | 18 months and 19-30 months | Participants |
| Other Pre-specified | PSA Screening in Men Aged 55 to 69 and Age 70 to 75 | Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period for men aged 55-69 and men aged 70-75 who are without a diagnosis suggesting a history of prostate cancer | Not Posted | 18 months and 19-30 months | Participants |
| Other Pre-specified | Rates of Urinalysis and Urine Culture Use in Women 65 and Older | Proportion of all women with one or more visit to an eligible clinic during the prior 12 months receiving urinalysis and/or urine culture | Not Posted | 18 months and 19-30 months | Participants |
| Other Pre-specified | Rate of Treatment for Antibiotics for UTI in Women 65 and Older | Proportion of all women with one or more encounter to an eligible clinic during the prior 12 months receiving an antibiotic for confirmed or possible UTI. | Not Posted | 18 months and 19-30 months | Participants |
| Other Pre-specified | Dose Reduction in Insulin, Sulfonylurea or Meglitinides | Proportion of patients 75 years old and older with initial HbA1c <7.0 and treated with insulin, sulfonylurea or meglitinides who have a dose reduction | Not Posted | 18 months, 24 months | Participants |
| Other Pre-specified | PSA Screening in Older Men by Race | NIH-required analysis. Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | Not Posted | 18 months | Participants |
| Other Pre-specified | PSA Screening in Older Men by Ethnicity | NIH-required analysis. Measure defined as the presence of a PSA laboratory result in the EHR during the measurement period among men aged 76 years and older at the start of the measurement period with at least one visit during the measurement period with a primary care clinician and who are without a diagnosis or procedure suggesting a history of prostate cancer. | Not Posted | 18 months | Participants |
| Other Pre-specified | Urine Testing for Non-specific Reasons by Race | NIH-required analysis. Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | Not Posted | 18 months | Participants |
| Other Pre-specified | Urine Testing for Non-specific Reasons by Ethnicity | NIH-required analysis. Measure defined as the absence of a diagnostic code for a specific genitourinary sign, symptoms or other potentially relevant indication among instances where a urinalysis and/or urine culture is obtained in the interval 24 hours before to 48 hours after a face-to-face ambulatory care visit by a woman aged 65 years or older with a primary care clinician during the measurement period. | Not Posted | 18 months | Participants |
| Other Pre-specified | Diabetes Overtreatment in the Elderly by Sex | NIH-required analysis. Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | Not Posted | 18 months | Participants |
| Other Pre-specified | Diabetes Overtreatment in the Elderly by Race | NIH-required analysis. Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | Not Posted | 18 months | Participants |
| Other Pre-specified | Diabetes Overtreatment in the Elderly by Ethnicity | NIH-required analysis. Measure defined as having the most recent hemoglobin A1C during the measurement period of less than 7.0 and insulin or an oral hypoglycemic drug on their active medication list at the end of the measurement period among adults aged 75 years and older with a diagnosis of diabetes mellitus. | Not Posted | 18 months | Participants |
| 511 |
| 18,709 |
| 996 |
| 38,607 |
| 11 |
| 668 |
| EG001 | Clinical Decision Support Nudges and Brief Clinician Education | Clinicians attributed to clinics randomized to the clinical decision support nudges and brief clinician decision support arm will receive clinical decision support within the EHR when conditions meet alert triggering criteria. These clinicians will also receive invitation to view an online educational module and be recruited to complete an online survey at baseline and 18 months. EHR clinical decision support nudges: Clinical decision support nudges delivered within the EHR when conditions meet alert triggering criteria. Brief clinician education: Clinicians will be invited to view brief education material. | 469 | 18,425 | 1,100 | 35,786 | 22 | 782 |
|
| EHR-Identified ED or hospital care possibly due to hyperglycemia | General disorders | Systematic Assessment | EHR-Identified ED or hospital care possibly due to hyperglycemia among previously tightly controlled. Adverse event were assessed for the specific population of subjects to which this measure applies. |
|
|
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| D004700 | Endocrine System Diseases |