Pulmonary Embolism
Conditions
Keywords
Clinical Decision Support, Pulmonary Embolism, Behavioral Design, Health Informatics
Brief summary
The central hypothesis of this proposal is that the addition of a theory-informed nudge to a clinical decision support (CDS) tool will address identified behavioral barriers to use and significantly improve adoption by providers. Nudges are applications of behavioral science, defined as positive reinforcement and indirect suggestions that have a non-forced effect on decision making. This study will use a behavioral theory-informed process to develop a new CDS tool that includes a nudge that addresses barriers to adoption.
Detailed description
The research team developed and pilot tested two CDS tools for pulmonary embolism (PE) risk stratification in the Emergency Department (ED). One of the tools incorporated two behavioral theory-informed nudges in the user interface. The research team's objective was to pilot test the tools to demonstrate feasibility as well as examine preliminary efficacy of the nudges on provider adoption of the tool. This cluster non-randomized controlled trial took place between September 20th, 2021 and March 3rd, 2022 in two EDs that are a part of a large academic health system in the New York City metropolitan area. All ED providers (physicians, physician assistants and nurse practitioners) seeing patients for the evaluation of PE during this time were included in the trial. The EDs were chosen based on their comparable size and acuity levels.
Interventions
OTHERPulmonary Embolism Risk Kalculator (PERK)
Nudges are applications of behavioral science, defined as positive reinforcement and indirect suggestions that have a non-forced effect on decision making. Nudges will be to the PE CALC CDS tool to develop the new CDS tool, PERK.
Sponsors
National Heart, Lung, and Blood Institute (NHLBI)
NYU Langone Health
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
25 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
* Medical doctors, nurse practitioners and physician assistants working full time at Huntington Hospital and Long Island Jewish Valley Stream
Exclusion criteria
* Does not meet the inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Patient Visits Where the Provider Adopted the Pulmonary Embolism Risk Kalculator (PERK) Tool | Up to Month 6 | The tool is considered adopted during a patient visit if the provider accepted the recommendation given by the PERK tool (i.e., a D-dimer was recommended and ordered or a CT pulmonary angiogram (CTPA) was recommended and ordered). This outcome measure is assessed using electronic health record (EHR) data from the patient visit. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of PE-Designated CTPA Tests That Are Positive for PE | Up to Month 6 | Monitored using EHR reporting data. Calculated as the percentage of CTPA tests ordered to evaluate for PE that are positive for PE. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention Site - Providers Providers at the site assigned to the intervention:
Full time employed Emergency Department providers will use the new CDS tool, Pulmonary Embolism Risk Kalculator (PERK), which includes nudges to improve use and will be integrated into the electronic medical record and will be accessible for 6 months
Pulmonary Embolism Risk Kalculator (PERK): Nudges are applications of behavioral science, defined as positive reinforcement and indirect suggestions that have a non-forced effect on decision making. Nudges will be to the PE CALC CDS tool to develop the new CDS tool, PERK. | 49 |
| No Intervention Site - Providers Providers at the site assigned to no intervention:
Full time employed Emergency Department providers used a CDS tool, Pulmonary Embolism Calculator (PE CALC), without nudges to improve use, to reduce unnecessary imaging in the diagnosis of pulmonary embolism (PE) in the emergency department (ED). | 35 |
| Intervention Site - Patients Patients at the site assigned to the intervention:
Full time employed Emergency Department providers will use the new CDS tool, Pulmonary Embolism Risk Kalculator (PERK), which includes nudges to improve use and will be integrated into the electronic medical record and will be accessible for 6 months
Pulmonary Embolism Risk Kalculator (PERK): Nudges are applications of behavioral science, defined as positive reinforcement and indirect suggestions that have a non-forced effect on decision making. Nudges will be to the PE CALC CDS tool to develop the new CDS tool, PERK. | 793 |
| No Intervention Site - Patients Patients at the site assigned to no intervention:
Full time employed Emergency Department providers used a CDS tool, Pulmonary Embolism Calculator (PE CALC), without nudges to improve use, to reduce unnecessary imaging in the diagnosis of pulmonary embolism (PE) in the emergency department (ED). | 735 |
| Total | 1,612 |
Baseline characteristics
| Characteristic | Intervention Site - Providers | No Intervention Site - Providers | Intervention Site - Patients | No Intervention Site - Patients | Total |
|---|---|---|---|---|---|
| Age, Continuous | 38 years | 35 years | 65 years | 64 years | 51 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | — | — | 69 Participants | 32 Participants | 101 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | — | — | 673 Participants | 617 Participants | 1290 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | — | — | 51 Participants | 86 Participants | 137 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | — | — | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | — | — | 14 Participants | 32 Participants | 46 Participants |
| Race (NIH/OMB) Black or African American | — | — | 42 Participants | 435 Participants | 477 Participants |
| Race (NIH/OMB) More than one race | — | — | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | — | — | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | — | — | 119 Participants | 122 Participants | 241 Participants |
| Race (NIH/OMB) White | — | — | 618 Participants | 146 Participants | 764 Participants |
| Region of Enrollment United States | 49 Participants | 35 Participants | 793 Participants | 735 Participants | 1612 Participants |
| Sex: Female, Male Female | — | — | — | — | 0 Participants |
| Sex: Female, Male Male | — | — | — | — | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 793 | 0 / 735 |
| other Total, other adverse events | 0 / 793 | 0 / 735 |
| serious Total, serious adverse events | 0 / 793 | 0 / 735 |
Outcome results
Primary
Percentage of Patient Visits Where the Provider Adopted the Pulmonary Embolism Risk Kalculator (PERK) Tool
The tool is considered adopted during a patient visit if the provider accepted the recommendation given by the PERK tool (i.e., a D-dimer was recommended and ordered or a CT pulmonary angiogram (CTPA) was recommended and ordered). This outcome measure is assessed using electronic health record (EHR) data from the patient visit.
Time frame: Up to Month 6
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention Site - Patients and Providers | Percentage of Patient Visits Where the Provider Adopted the Pulmonary Embolism Risk Kalculator (PERK) Tool | 39.11 Percentage of Patient Visits |
| No Intervention Site - Patients and Providers | Percentage of Patient Visits Where the Provider Adopted the Pulmonary Embolism Risk Kalculator (PERK) Tool | 20.66 Percentage of Patient Visits |
Secondary
Percentage of PE-Designated CTPA Tests That Are Positive for PE
Monitored using EHR reporting data. Calculated as the percentage of CTPA tests ordered to evaluate for PE that are positive for PE.
Time frame: Up to Month 6
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intervention Site - Patients and Providers | Percentage of PE-Designated CTPA Tests That Are Positive for PE | 26.45 Percentage of PE-Designated CTPA Tests |
| No Intervention Site - Patients and Providers | Percentage of PE-Designated CTPA Tests That Are Positive for PE | 10.76 Percentage of PE-Designated CTPA Tests |