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
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE
Enrollment
8,640
Change/introduction of default drug and frequency during electronic prescribing of high-risk drugs for a patient aged ≥65 years
NYC Health+Hospitals
New York, New York, United States
Icahn School of Medicine at Mount Sinai
New York, New York, United States
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.
Time frame: 24 weeks
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).
Time frame: 24 weeks
Mean per-patient dose
Mean per-patient dose of the relevant individual high-risk drugs.
Time frame: 24 weeks
Rate of inpatient falls
Inpatient falls (with and without injury)
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 24 weeks
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