Drug Utilization Review, Physician's Practice Patterns, Prescribing Patterns, Physician
Conditions
Keywords
Proton Pump Inhibitors, Quality Improvement, Healthcare Utilization, Clinical Decision Support, resource utilization
Brief summary
The proposed study is a quality improvement initiative designed to rigorously evaluate new variations of UCLA Health's proton pump inhibitor (PPI) order panels, building on internal quality improvement efforts to optimize prescribing workflows within the Electronic Health Record (EHR). PPIs are notoriously overprescribed, and the study team has identified that the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether modifying defaulted prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority. This evaluation of PPI order panel variations is embedded within UCLA's existing EHR system, ensuring that changes are tested pragmatically within routine workflows. The study aims to determine whether small adjustments to the order panel can better align prescribing patterns with clinical best practices while maintaining physician autonomy.
Interventions
BEHAVIORALAlgorithmic Defaulting (Indication-Based Default)
PPIs are frequently overprescribed, and the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether modifying defaulted prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority.
BEHAVIORALActive Physician Choice
PPIs are frequently overprescribed, and the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether requiring providers to actively select prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority.
Sponsors
University of California, Los Angeles
National Institute on Aging (NIA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* UCLA Health primary care physicians who have a clinical full-time equivalency of at least 25%.
Exclusion criteria
* Physicians with a clinical full-time equivalency of less than 25%
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Inappropriate Pill Days | 12 months | The study will take place within the existing UCLA Health Electronic Health Record (EHR) infrastructure. Data will be automatically collected from the EHR, focusing on pill days in excess of guidelines. The trial team will validate an eMeasure of inappropriate prescriptions as the primary outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Prescription Discontinuations | 12 months | The study will take place within the existing UCLA Health EHR infrastructure. Data will be automatically collected from the EHR, focusing on prescriptions that have been discontinued for 90 days or more. |
| Prescription Refills | 12 months | The study will take place within the existing UCLA Health EHR infrastructure. Data will be automatically collected from the EHR, focusing on prescriptions that are refilled. |
| Overall Average Pill Days | 12 months | The study will take place within the existing UCLA Health EHR infrastructure. Data will be automatically collected from the EHR, focusing on pill days overall. |
| GI Bleeding Hospitalization | 12 months | Balancing measure to ensure reducing PPIs does not lead to harm. |
Countries
United States
Contacts
CONTACTKatelyn Clinical Research Coordinator
Outcome results
None listed