Behavioral Economics Applications to Geriatrics Leveraging EHRs

NCT03704389 | Completed Results

• 2 other identifiers: STU00205722R21AG057383
• Study Type: interventional
• Target: 664
• Locations: 1 country
• Sites: 1

Brief Summary

The risks and benefits of many diagnostic approaches and treatments differ for older adults compared to middle aged adults. When diagnostic and therapeutic strategies are misapplied to older adults this can lead to increased morbidity and mortality. Well established examples where clinicians do not often follow best practices in the care of older adults include those identified by the American Geriatrics Society for the Choosing Wisely initiative: 1) testing and treatment for asymptomatic bacteriuria, 2) prostate specific antigen testing in older men without prostate cancer, and 3) overuse of insulin or oral hypoglycemics for type 2 diabetes. Clinical decision support nudges, informed by social psychology and delivered via electronic health records (EHRs), are promising strategies to reduce the misuse of services in cases where optimal utilization may not be zero but should be well below current practice. These interventions seek to influence conscious and unconscious drivers of clinical decision making, are low cost to implement and disseminate, and can be incorporated into existing delivery systems. In the R21 phase of this Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE) study, we will: select EHR delivered nudges to address 3 topics of potential misuse in older adults based on the main psychological drivers of overuse identified in interviews with high-using clinicians; develop and pilot test decision support tools within a health systems' EHR to understand technical feasibility, work flow fit, preliminary impact on clinical outcomes, and clinician acceptability; and develop and validate electronic clinical quality measures of potential overuse/misuse related to the care of older adults.

Conditions

Prostate Specific Antigen; Asymptomatic Bacteriuria; Type 2 Diabetes Mellitus

Keywords

Geriatrics; Clinical decision support; Behavioral Economics

Outcome Measures

Primary Outcomes (3)

• Misuse of Urinalysis or Urine Culture in Older Women

  Percentage of women patients aged 65 years and older who underwent a urinalysis and/or urine culture for suspected urinary tract infection (UTI) who did not have genitourinary specific symptoms

  6 months intervention period

• Prostate-Specific Antigen (PSA) Testing in the Elderly

  Percent of male patients seen by participating clinicians 76 and older with no history of prostate cancer who had a PSA test done during the measurement period

  6 month intervention period

• Diabetes Overtreatment in the Elderly

  Percent of diabetes patients 75 and older treated with insulin or oral hypoglycemic with hemoglobin A1c less than 7.0.

  6 month intervention period

Study Arms (1)

Clinical decision support intervention

EXPERIMENTAL

Participating clinicians will receive any of three clinical decision support nudges within the electronic health record when all eligibility criteria are met within a patient's chart.

Behavioral: Clinical decision support

Interventions

Clinical decision support BEHAVIORAL

Clinical decision support nudges within the electronic health record

Clinical decision support intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Northwestern Medicine primary care clinician caring for adults
• Provides informed consent

Sponsors & Collaborators

• Northwestern University: lead
• University of California, Los Angeles: collaborator
• University of Southern California: collaborator
• National Institute on Aging (NIA): collaborator

Study Sites (1)

Northwestern Medicine

Chicago, Illinois, 60611, United States

Location

MeSH Terms

Conditions

Diabetes Mellitus, Type 2

Condition Hierarchy (Ancestors)

Diabetes Mellitus; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases

Results Point of Contact

• Title: Stephen D. Persell, MD, MPH, FACP
• Organization: Northwestern University

spersell@nm.org

312-503-6464

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 9, 2018
• First Posted: October 12, 2018
• Study Start: January 17, 2019
• Primary Completion: July 17, 2019
• Study Completion: August 18, 2019
• Last Updated: October 7, 2025
• Results First Posted: October 7, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)