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| Name | Class |
|---|---|
| New York City Health and Hospitals Corporation | OTHER |
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This study will assess whether a modification in the default dose and frequency (the first option a provider sees) during electronic prescribing of a high-risk drug can impact prescribing behavior and subsequent changes in average dose for the targeted high-risk drug, when prescribed to a hospitalized patient aged ≥65 years. In this cluster randomized crossover (CRXO) trial we will randomize a non-intrusive "nudge" intervention, which involves modifying the default dose for high-risk drugs when prescribed electronically to hospitalized patients aged ≥65 years. The CRXO trial involves 10 sites in an urban health system: five sites will start the trial under the intervention/control during a first time period (T1) after which they switch intervention/control status (T2). The primary outcome is prescription rate of a lower default dose (i.e. the geriatric standard) for 8 high-risk drugs. This study will inform the effectiveness of EHR-based "nudge" interventions to reduce inappropriate prescribing of high-risk drugs for elderly patients.
Analyses ongoing, expected to finalize spring 2023
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | No Intervention | No change in default dose or frequency selected for the eight targeted drugs | |
| Intervention | Experimental | The first option a prescriber sees when prescribing any of eight high-risk drugs for elderly hospitalized patients will be modified; the first frequency option a prescriber sees will be modified as well. Providers retain the ability to prescribe any dose or frequency. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EHR-based "nudge" interventions | Behavioral | Change/introduction of default drug and frequency during electronic prescribing of high-risk drugs for a patient aged ≥65 years |
|
| Measure | Description | Time Frame |
|---|---|---|
| Prescription rate of modified default dose for eight high-risk drugs | Rate at which the modified default dose (geriatric standard) and frequency for eight high-risk drugs are prescribed. | 24 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Drug-specific prescription rate | Drug-specific prescription rate of the modified default dose for each of the eight high-risk medications and type of order (frequency/type of order). | 24 weeks |
| Mean per-patient dose |
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Inclusion Criteria:
Exclusion Criteria:
- none
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| Name | Affiliation | Role |
|---|---|---|
| Jashvant Poeran, MD, PhD | Icahn School of Medicine at Mount Sinai | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| NYC Health+Hospitals | New York | New York | 10013 | United States | ||
| Icahn School of Medicine at Mount Sinai |
Sharing IPD was not something including in the IRB application process. Only aggregated data will be disseminated.
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This cluster randomized crossover (CRXO) trial involves 10 sites in an urban health system: five clinics will start the trial under the intervention/control during a first time period (T1) then will switch to intervention/control status (T2). The primary outcome is prescription rate of a lower default dose for 8 high-risk drugs.
Other inputs used for trial design were: baseline rate of prescriptions meeting the geriatric standard (sources: local data, Geriatrics At Your Fingertips), within-period intraclass correlation coefficient (ICC, correlation between two randomly chosen observations in the same cluster), cluster autocorrelation (ratio of between-period ICC to within-period ICC), and coefficient of variation of cluster sizes (required when unequal sample size per cluster is expected). The aim is for ≥80% power to detect a ≥50% increase in prescriptions meeting the geriatric standard; this is based on previous studies and on the researchers' preliminary data on Trazodone.
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Participants and care providers will be unaware of the intervention. However, prescribers will be able to prescribe all available doses, without any restrictions
Mean per-patient dose of the relevant individual high-risk drugs.
| 24 weeks |
| Rate of inpatient falls | Inpatient falls (with and without injury) | 24 weeks |
| Rate of 30-day readmissions | 30-day readmission rates for patients aged ≥65 years who received any of the eight high-risk drugs during their hospitalization. | 30 days post-discharge regarding hospitalization during which a high-risk drug was prescribed |
| Length of hospital stay | Duration of hospitalization in days for patients aged ≥65 years who received any of the eight high-risk drugs during their hospitalization. | 24 weeks |
| Cost of hospital stay | Cost of hospitalization in USD for patients aged ≥65 years who received any of the eight high-risk drugs during their hospitalization. | 24 weeks |
| Spillover effects to patients aged <65 | The rate of prescriptions of the newly defaulted (geriatric) dose for any of the eight high-risk drugs among patients aged <65 years. | 24 weeks |
| New York |
| New York |
| 10029 |
| United States |