Nudging Provider Adoption of Clinical Decision Support: Implementation of an EHR-Agnostic Pulmonary Embolism Risk Prediction Tool
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Clinical Decision Support (CDS) tool with Nudges.
- Who it may be relevant to
- Registry conditions: Pulmonary Embolism. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
The purpose of this study is to examine the impact of the nudge implementation strategy (CDS tool + Nudge) on adoption of guideline-concordant CT ordering for pulmonary embolism (PE) in 10 EDs. The study will be a 33-month, rigorous, pragmatic, cluster-randomized, stepped wedge trial across 3 health systems and 10 EDs after collecting pre-implementation baseline data. The aim is to to demonstrate technological feasibility as well as examine efficacy of the nudges on adoption. The secondary objective is to decrease CT-ordering when it is not indicated.
Detailed description
Part 1 of the study included the collection of data. During the pre-implementation period each sites electronic health record (EHR) and baseline data was collected for 12 months. In Part 2, the study will examine the impact of the nudge implementation strategy (CDS tool + Nudge) on adoption of guideline-concordant CT ordering for PE in 10 EDs. Adoption outcomes data will be collected through EHR reporting systems.
Interventions
- Behavioral Clinical Decision Support (CDS) tool with Nudges
The CDS tool with nudges provide information to providers to practice medicine in accordance with CT (computed tomography) ordering guidelines. The tool will only deploy when the provider is going against clinical guidelines and therefore provides a chance for the provider to reconsider their actions.
Primary outcome measures
- Percentage of CT scan orders that are guideline-concordant [Time frame: Baseline (Month 12)]
- Percentage of CT scan orders that are guideline-concordant [Time frame: End of intervention (Month 45)]
Eligibility criteria
Inclusion criteria
- 18 years of older
- A provider (MD, NP, PA) ordering CTs for evaluation of PE in adult patients present at study site Emergency Department (i.e., Northwell Health - Feinstein Institute for Medical Research, Baylor College of Medicine and NYU Langone Health).
Exclusion criteria
1\. A provider not present at the specified study sites.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Allocation
- N/A
- Model
- Single group
- Masking
- Open label
- Primary purpose
- Supportive care
Study locations
United States · 3 centers
- Northwell Health - Feinstein Institute for Medical Research — Manhasset
- NYU Langone Health — New York
- Baylor College of Medicine — Houston
Publications
- Khan S, Thomas Y, Garg N, Genes N, Simon GW, Cleland CM, Mir U, Dauber-Decker KL, Solomon JN, Shunk A, Xu L, Mastrianni A, Cui Y, Henning N, Diefenbach MA, McGinn T, Richardson S. Nudging provider adoption of clinical decision support: study protocol for a stepped-wedge cluster randomized, hybrid type III trial of an electronic health record-agnostic pulmonary embolism risk tool. Implement Sci. 20 PMID 42186073
Identifiers
NCT: NCT07249385 · 23-01528 · 5R01HL169364-02