An Electronic Clinical Decision Support Tool to Reduce Low-value Antipsychotic Prescriptions

NCT04851691 | Completed Results DMC

• 2 other identifiers: R01AG059815-01S11R01AG059815-01
• Study Type: interventional
• Target: 158
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this study will be to design, implement and test the impact of a quality improvement (QI) intervention that uses an EHR CDS tool among physicians newly ordering an antipsychotic medication for older adults with ADRD. The study team hypothesizes that the intervention will reduce each participating clinician's pill days per patient prescribed.

Conditions

Alzheimer Disease; Dementia Alzheimers; Dementia of Alzheimer Type

Keywords

Low Value Care; Antipsychotic medication

Outcome Measures

Primary Outcomes (1)

• Cumulative Total of New Antipsychotic Pill-days Prescribed

  Cumulative total of new antipsychotic prescription days supplied by clinicians per eligible patient in the 12 months after the intervention rollout date compared to the prior 12-months

  12 month time point

Secondary Outcomes (5)

• Number of Patients Who Receive Handout

  12 month time point

• Number of Patients With ER Visit

  90 days

• Number of Patients With Hospitalization

  90 days

• Hospitalizations (Including Psychiatric Hospitalizations)

  90 days

• Death Within 90 Days After Enrollment

  90 days

Study Arms (2)

EHR CDS tool

EXPERIMENTAL

Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the EHR CDS tool. Multi-pronged electronic health record (EHR) clinical decision support (CDS) tool intervention to reduce physician prescriptions of new antipsychotic medications among older adults with ADRD

Behavioral: EHR CDS

Control

EXPERIMENTAL

Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the control. Physicians will not receive intervention and perform duties as usual.

Other: Usual Care

Interventions

EHR CDS BEHAVIORAL

When a clinician initiates a new antipsychotic prescription for a patient with dementia, a three-pronged electronic health record clinical decision support tool "pops up": (1) Alerting clinicians that antipsychotic prescriptions increase patient mortality; (2) Offering non-pharmacological behavioral resources for caregivers via a link to the IDEA! strategy resources on how caregivers can best manage a patient's behavioral disturbance non-pharmacologically, which will be available in the EHR to include in the patient's after visit summary; and (3) Defaulting prescriptions to a low supply of pills in to order to minimize harm. In addition, the PI will email all providers randomized to the intervention arm in order to make them aware of the components of this intervention and its motivation.

EHR CDS tool

Usual Care OTHER

Patients will receive usual care from their physicians.

Control

Eligibility Criteria

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

You may qualify if:

• Physicians who will be eligible to receive the EHR CDS tool intervention include those who provide ambulatory care in the UCLA health system and have newly prescribed antipsychotics (e.g., Quetiepine, Olanzapine, Risperidone, Aripiprazole, Haloperidol, Clozapine) for eligible patients (described below) at the medical center in the last 24 months.

You may not qualify if:

• Patients who have diagnosis codes for schizophrenic disorders, delusion disorders, bipolar disorders, or other non-organic psychoses on their problem list.
• Patients with Parkinson's disease on their problem list
• Patients who have been prescribed antipsychotics in the prior 12 months

Sponsors & Collaborators

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

Study Sites (1)

UCLA Health

Los Angeles, California, 90095, United States

Location

Related Publications (19)

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• Seppi K, Ray Chaudhuri K, Coelho M, Fox SH, Katzenschlager R, Perez Lloret S, Weintraub D, Sampaio C; the collaborators of the Parkinson's Disease Update on Non-Motor Symptoms Study Group on behalf of the Movement Disorders Society Evidence-Based Medicine Committee. Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review. Mov Disord. 2019 Feb;34(2):180-198. doi: 10.1002/mds.27602. Epub 2019 Jan 17.

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MeSH Terms

Conditions

Alzheimer Disease

Condition Hierarchy (Ancestors)

Dementia; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Tauopathies; Neurodegenerative Diseases; Neurocognitive Disorders; Mental Disorders

Results Point of Contact

• Title: Project Manager
• Organization: University of California Los Angeles, Division of General Internal Medicine and Health Services Research

cvillaflores@mednet.ucla.edu

310-825-8253

Study Officials

• Catherine A Sarkisian, MD, MSPH

  University of California, Los Angeles

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: April 2, 2021
• First Posted: April 20, 2021
• Study Start: August 3, 2021
• Primary Completion: April 11, 2023
• Study Completion: August 14, 2023
• Last Updated: September 19, 2024
• Results First Posted: September 19, 2024

Record last verified: 2024-08

Locations

US (1)