Effect of Passive Choice and Active Choice Interventions in the Electronic Health Record to Cardiologists on Statin Prescribing: A Cluster Randomized Clinical Trial.

Autor:	Adusumalli S; Penn Medicine, University of Pennsylvania, Philadelphia.; Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Westover JE; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Jacoby DS; Penn Medicine, University of Pennsylvania, Philadelphia.; Perelman School of Medicine, University of Pennsylvania, Philadelphia., Small DS; Wharton School, University of Pennsylvania, Philadelphia., VanZandbergen C; Penn Medicine, University of Pennsylvania, Philadelphia., Chen J; Penn Medicine, University of Pennsylvania, Philadelphia., Cavella AM; Penn Medicine, University of Pennsylvania, Philadelphia., Pepe R; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Rareshide CAL; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Snider CK; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Volpp KG; Penn Medicine, University of Pennsylvania, Philadelphia.; Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Wharton School, University of Pennsylvania, Philadelphia.; Crescenz Veterans Affairs Medical Center, Philadelphia., Asch DA; Penn Medicine, University of Pennsylvania, Philadelphia.; Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Wharton School, University of Pennsylvania, Philadelphia.; Crescenz Veterans Affairs Medical Center, Philadelphia., Patel MS; Penn Medicine, University of Pennsylvania, Philadelphia.; Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia.; Wharton School, University of Pennsylvania, Philadelphia.; Crescenz Veterans Affairs Medical Center, Philadelphia.
Jazyk:	angličtina
Zdroj:	JAMA cardiology [JAMA Cardiol] 2021 Jan 01; Vol. 6 (1), pp. 40-48.
DOI:	10.1001/jamacardio.2020.4730
Abstrakt:	Importance: Statin therapy is underused for many patients who could benefit. Objective: To evaluate the effect of passive choice and active choice interventions in the electronic health record (EHR) to promote guideline-directed statin therapy. Design, Setting, and Participants: Three-arm randomized clinical trial with a 6-month preintervention period and 6-month intervention. Randomization conducted at the cardiologist level at 16 cardiology practices in Pennsylvania and New Jersey. The study included 82 cardiologists and 11 693 patients. Data were analyzed between May 8, 2019, and January 9, 2020. Interventions: In passive choice, cardiologists had to manually access an alert embedded in the EHR to select options to initiate or increase statin therapy. In active choice, an interruptive EHR alert prompted the cardiologist to accept or decline guideline-directed statin therapy. Cardiologists in the control group were informed of the trial but received no other interventions. Main Outcomes and Measures: Primary outcome was statin therapy at optimal dose based on clinical guidelines. Secondary outcome was statin therapy at any dose. Results: The sample comprised 11 693 patients with a mean (SD) age of 63.8 (9.1) years; 58% were male (n = 6749 of 11 693), 66% were White (n = 7683 of 11 693), and 24% were Black (n = 2824 of 11 693). The mean (SD) 10-year atherosclerotic cardiovascular disease (ASCVD) risk score was 15.4 (10.0); 68% had an ASVCD clinical diagnosis. Baseline statin prescribing rates at the optimal dose were 40.3% in the control arm, 39.1% in the passive choice arm, and 41.2% in the active choice arm. In adjusted analyses, the change in statin prescribing rates at optimal dose over time was not significantly different from control for passive choice (adjusted difference in percentage points, 0.2; 95% CI, -2.9 to 2.8; P = .86) or active choice (adjusted difference in percentage points, 2.4; 95% CI, -0.6 to 5.0; P = .08). In adjusted analyses of the subset of patients with clinical ASCVD, the active choice intervention resulted in a significant increase in statin prescribing at optimal dose relative to control (adjusted difference in percentage points, 3.8; 95% CI, 1.0-6.4; P = .008). No other subset analyses were significant. There were no significant changes in statin prescribing at any dose for either intervention. Conclusions and Relevance: The passive choice and active choice interventions did not change statin prescribing. In the subgroup of patients with clinical ASCVD, the active choice intervention led to a small increase in statin prescribing at the optimal dose, which could inform the design or targeting of future interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT03271931.
Databáze:	MEDLINE
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