Education of Providers on Prescribing Best Practices

This study aims to evaluate the impact of spaced education, delivered via a smartphone application, on provider prescribing patterns.

Study Overview

• Status: Completed
• Conditions: Education
• Intervention / Treatment: Behavioral: Quiztime modules

Detailed Description

As part of a medical center educational initiative at Vanderbilt University Medical Center (VUMC), two educational modules will be sent to prescribing providers through either email or short message service (SMS) text messaging. The first educational module consists of a set of multiple choice questions concerning best practices for prescribing intravenous fluids in the inpatient and perioperative setting. This module is based upon recent literature and specifically derived from the results of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED) trial, both published in the New England Journal of Medicine in 2018 and led by Vanderbilt investigators. Similarly, a second educational module concerning evidence-based pain management and opioid prescribing practices will be distributed via email or SMS text messaging.

Participants will receive one question per day. If the participant does not answer the question correctly, they will receive the opportunity to attempt the question again after reviewing evidence-based education. All questions have been curated and reviewed by a panel of experts and piloted within VUMC for feasibility and acceptability. Key concepts are repeated in each module and questions are strategically ordered throughout each module to accomplish spaced education.

• Study Type: Interventional
• Enrollment (Actual): 369
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Tennessee
    • Nashville, Tennessee, United States, 37232
      • Vanderbilt University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• All inpatient prescribing providers

Exclusion Criteria:

• none

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Opioid module first then fluid; The providers in this arm will first receive daily information and questions related to opioid use for eight weeks and then daily information and questions related to intravenous fluid prescribing for five weeks.	Behavioral: Quiztime modules; Text Messaging or Email system
Active Comparator: Fluid module first then opioid; The providers in this arm will first receive daily information and questions related to intravenous fluid prescribing for five weeks and then daily information and questions related to opioid use for eight weeks.	Behavioral: Quiztime modules; Text Messaging or Email system

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Median morphine milligram equivalents (MME) per opioid prescription	By extracting prescribing data for opioids from the electronic health records	8 months
Percentage of orders for balanced intravenous (IV) fluid solutions (i.e. not normal saline)	By extracting prescribing data for intravenous fluids from the electronic health records	8 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chloride levels in patients receiving intravenous fluid orders from a provider enrolled in the study	By extracting chloride level data from the electronic health records	8 months
Potassium levels in patients receiving intravenous fluid orders from a provider enrolled in the study	By extracting potassium level data from the electronic health records	8 months
Major Adverse Kidney Events by 30 days (MAKE 30) in patients receiving intravenous fluid orders from a provider enrolled in the study	By extracting data from the electronic health records	30 days
Length of stay for patients receiving an intravenous fluid order or an opioid prescription from a provider enrolled in the study.	By extracting length of stay data from the electronic health records	8 months
Length of stay in the intensive care unit (ICU) for patients receiving an intravenous fluid order or an opioid prescription from a provider enrolled in the study	By extracting ICU length of stay from the electronic health records	8 months
Median number of pills per prescription for patients receiving an opioid prescription from a provider enrolled in the study	By extracting medication data from the electronic health records	8 months
Percent of opioid prescriptions (inpatient) that also had a scheduled (not pro re nata (PRN)) non-opioid (APAP, nonsteroidal anti-inflammatory drugs (NSAIDs), gamma-Aminobutyric acid (GABA), muscle relaxant, etc.)	By extracting medication data from the electronic health records	8 months
Percent of opioid prescriptions (discharge) that also had a scheduled (not PRN) non-opioid (APAP, NSAIDs, GABA, muscle relaxant, etc.)	By extracting medication data from the electronic health records	8 months
Number of Rapid Response Team calls (RRT s) indexed to the number of patients cared for per prescriber (evaluated by level of engagement of the learner with QuizTime)	By extracting RRT calls from the electronic health records	8 months

Collaborators and Investigators

• Sponsor: Vanderbilt University Medical Center
• Investigators: Principal Investigator: Matthew McEvoy, MD, Vanderbilt University Medical Center

Publications and helpful links

General Publications

• McEvoy MD, Dear ML, Buie R, Edwards DA, Barrett TW, Allen B, Robertson AC, Fowler LC, Hennessy C, Miller BM, Garvey KV, Bland RP 3rd, Fleming GM, Moore D, Rice TW, Bernard GR, Lindsell CJ; Vanderbilt Learning Healthcare System Platform Investigators and the Vanderbilt Committee on Opioid Monitoring and Stewardship. Effect of Smartphone App-Based Education on Clinician Prescribing Habits in a Learning Health Care System: A Randomized Cluster Crossover Trial. JAMA Netw Open. 2022 Jul 1;5(7):e2223099. doi: 10.1001/jamanetworkopen.2022.23099.
• McEvoy MD, Dear ML, Buie R, Fowler LC, Miller B, Fleming GM, Moore D, Rice TW, Bernard GR, Lindsell CJ; Vanderbilt Learning Healthcare System Investigators. Embedding Learning in a Learning Health Care System to Improve Clinical Practice. Acad Med. 2021 Sep 1;96(9):1311-1314. doi: 10.1097/ACM.0000000000003969.

Study record dates

Study Major Dates

• Study Start (Actual): December 30, 2019
• Primary Completion (Actual): June 15, 2020
• Study Completion (Actual): June 15, 2020

Study Registration Dates

• First Submitted: December 7, 2018
• First Submitted That Met QC Criteria: December 7, 2018
• First Posted (Actual): December 11, 2018

Study Record Updates

• Last Update Posted (Actual): October 14, 2020
• Last Update Submitted That Met QC Criteria: October 13, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: 190371 (Other Identifier: University of Ibadan)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: Data dictionaries and individual participant data that underlie the results reported after de-identification will be available.
• IPD Sharing Time Frame: 3 months after publication for 5 years
• IPD Sharing Access Criteria: Researchers who provide a methodologically sound proposal that has been approved by the Vanderbilt Institutional Review Board and the study executive committee.
• IPD Sharing Supporting Information Type: Study Protocol; Statistical Analysis Plan (SAP); Analytic Code

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No