Evaluation of Alerts in Promoting Bone Densitometry Scans

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

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.

Study Overview

• Status: Withdrawn
• Conditions: Bone Diseases; Communication
• Intervention / Treatment: Behavioral: Health Maintenance Topic; Behavioral: Actionable Sidebar Item; Behavioral: Best Practice Alert

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.

• Study Type: Interventional
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

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

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard of Care; A health maintenance topic, actionable sidebar item, and a single-click best practice alert are presented.	Behavioral: Health Maintenance Topic; Alert; Other Names: HMT; Behavioral: Actionable Sidebar Item; Alert; Other Names: Storyboard; Behavioral: Best Practice Alert; Alert; Other Names: BPA
Experimental: Silent Best Practice Alert; A health maintenance topic and an actionable sidebar item are presented. The best practice alert is set to be silent and will not appear in the patient's chart.	Behavioral: Health Maintenance Topic; Alert; Other Names: HMT; Behavioral: Actionable Sidebar Item; Alert; Other Names: Storyboard

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
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

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
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
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
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
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
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
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
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

Collaborators and Investigators

• Sponsor: Geisinger Clinic
• Investigators: Principal Investigator: Amir Goren, PhD, Program Director, Behavioral Insights Team

Study record dates

Study Major Dates

• Study Start (Anticipated): March 1, 2022
• Primary Completion (Anticipated): December 1, 2022
• Study Completion (Anticipated): December 1, 2022

Study Registration Dates

• First Submitted: June 22, 2021
• First Submitted That Met QC Criteria: June 29, 2021
• First Posted (Actual): July 9, 2021

Study Record Updates

• Last Update Posted (Actual): March 31, 2022
• Last Update Submitted That Met QC Criteria: March 16, 2022
• Last Verified: March 1, 2022

More Information

Terms related to this study

• Keywords: Bone Diseases; Alerts; Densitometry; Dual Energy X-ray Absorptiometry Scan
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Bone Diseases
• Other Study ID Numbers: 2020-0996

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
• IPD Sharing Time Frame: The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
• IPD Sharing Access Criteria: The data on the Open Science Framework will be open to anyone requesting that information.
• IPD Sharing Supporting Information Type: Study Protocol; 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