Evaluation of Alerts in Promoting Bone Densitometry Scans

Communication Clinical Trial

Official title:

Evaluation of Best Practice Alerts and an Actionable Sidebar in Electronic Health Records in Promoting Bone Densitometry Scans

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT04955652
• Other study ID #: 2020-0996
• Status: Withdrawn
• Phase: N/A
• Start date: March 2022
• Est. completion date: December 2022

Study information

• Verified date: March 2022
• Source: Geisinger Clinic
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to assess, prospectively, the effect of provider-facing alerts for bone densitometry scans with and without a single-click best practice alert (BPA) on scan orders and completions. The investigators hypothesize that the remaining alerts left in place (via health maintenance topics and an actionable item in the electronic health record sidebar) will be as effective without the BPA compared to the alerts with a BPA.

Description:

Standard care for bone densitometry scans at Geisinger--i.e., dual-energy x-ray absorptiometry (DXA) scans--involves (1) an alert under the health maintenance topics tab in Epic, (2) an actionable item in a sidebar (Storyboard), (3) and a single-click best practice alert (BPA). Storyboard and the BPA theoretically serve a redundant function, but it is possible that combined alerting is effective. Therefore, the investigators plan to evaluate whether the BPA for DXA scans will increase the percentage of DXA scans ordered and completed. For this evaluation, the investigators will randomly assign (by odd and even MRN) half of patients who need DXA scans to go through standard care (including the single-click BPA) and half of patients to have no BPA shown to their provider, but only the health maintenance topic and actionable Storyboard alert. This evaluation will help the investigators determine whether redundant, more traditional alerts such as BPAs are helpful or can be removed from alerts for DXA scans. The randomization of patients to different alert conditions will be in place until 4,200 participants have been reached (estimated sample to detect 4% absolute difference, rounded to nearest hundred) or 6 months, whichever comes first. To account for delays in updating clinical databases, the outcome data will pulled 3 months after each encounter (for a maximum study period of 9 months). The main analysis will use a logistic regression to compare the two groups. Exploratory analyses will also examine the time from order to completion to examine any effect on timing between arms. Another set of exploratory analyses will also examine the number of other BPAs firing to see if alert fatigue influenced the number of orders or completions or interacted with the experimental conditions.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: December 2022
• Est. primary completion date: December 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• In primary care
• Records indicate patient is due for a bone densitometry scan (generally, a high-risk patient that requires this scan or age 65 and older)

Exclusion Criteria:

• Encounters at clinics/sites where the randomization build cannot easily be deployed

Related Conditions & MeSH terms

• Bone Diseases
• Communication

Intervention

Behavioral:
• Health Maintenance Topic
Alert
• Actionable Sidebar Item
Alert
• Best Practice Alert
Alert

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Geisinger Clinic

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Bone Densitometry Scan Completion Time	Number of days from order time to completion time	6 months or as long as it takes to reach N=4,200, whichever occurs first
Other	Number of Unique Alerts	Number of unique alerts (BPAs and medication alerts) that fired at the encounter	6 months or as long as it takes to reach N=4,200, whichever occurs first
Other	Number of Alerts Fired	Number of alerts (BPAs and medication alerts) that fired at the encounter	6 months or as long as it takes to reach N=4,200, whichever occurs first
Other	Total number of BPAs	Total number of BPAs that fired at the encounter	6 months or as long as it takes to reach N=4,200, whichever occurs first
Other	Total number of medication alerts	Total number of medication alerts that fired at the encounter	6 months or as long as it takes to reach N=4,200, whichever occurs first
Other	Total number of passive alerts	Total number of passive alerts that fired at the encounter	6 months or as long as it takes to reach N=4,200, whichever occurs first
Other	Total number of interruptive alerts	Total number of interruptive alerts that fired at the encounter	6 months or as long as it takes to reach N=4,200, whichever occurs first
Primary	Bone Densitometry Scan Order Placed	Binary variable indicating whether or not the order was placed	6 months or as long as it takes to reach N=4,200, whichever occurs first
Secondary	Bone Densitometry Scan Completed	Binary variable indicating whether or not the order placed at the encounter was completed	6 months or as long as it takes to reach N=4,200, whichever occurs first