Bone Diseases, Communication
Conditions
Keywords
Bone Diseases, Alerts, Densitometry, Dual Energy X-ray Absorptiometry Scan
Brief 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.
Detailed 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.
Interventions
BEHAVIORALHealth Maintenance Topic
Alert
BEHAVIORALActionable Sidebar Item
Alert
BEHAVIORALBest Practice Alert
Alert
Sponsors
Geisinger Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Masking description
The participants and providers will not know that alerts were randomized. Participants will not know the arm to which they were assigned. Providers might notice that a given participant did or did not receive a certain alert, but this is expected to be unlikely, given the volume of alerts to which providers are exposed constantly.
Intervention model description
1 x 2 factorial design, with randomization happening at the patient level
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Bone Densitometry Scan Order Placed | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Binary variable indicating whether or not the order was placed |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bone Densitometry Scan Completed | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Binary variable indicating whether or not the order placed at the encounter was completed |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Alerts Fired | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Number of alerts (BPAs and medication alerts) that fired at the encounter |
| Total number of BPAs | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Total number of BPAs that fired at the encounter |
| Bone Densitometry Scan Completion Time | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Number of days from order time to completion time |
| Total number of passive alerts | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Total number of passive alerts that fired at the encounter |
| Total number of interruptive alerts | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Total number of interruptive alerts that fired at the encounter |
| Total number of medication alerts | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Total number of medication alerts that fired at the encounter |
| Number of Unique Alerts | 6 months or as long as it takes to reach N=4,200, whichever occurs first | Number of unique alerts (BPAs and medication alerts) that fired at the encounter |
Outcome results
None listed