Optimizing Proton Pump Inhibitors (PPI) Prescribing With EHR-Based Decision Support

NCT06998966 | Recruiting

• 2 other identifiers: IRB-25-02311K76AG064392-01A1
• Study Type: interventional
• Target: 372
• Locations: 1 country
• Sites: 1

Brief Summary

The proposed study is a quality improvement initiative designed to rigorously evaluate new variations of UCLA Health's proton pump inhibitor (PPI) order panels, building on internal quality improvement efforts to optimize prescribing workflows within the Electronic Health Record (EHR). PPIs are notoriously overprescribed, and the study team has identified that the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether modifying defaulted prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority. This evaluation of PPI order panel variations is embedded within UCLA's existing EHR system, ensuring that changes are tested pragmatically within routine workflows. The study aims to determine whether small adjustments to the order panel can better align prescribing patterns with clinical best practices while maintaining physician autonomy.

Conditions

Prescribing Patterns, Physician; Physician's Practice Patterns; Drug Utilization Review

Keywords

Proton Pump Inhibitors; Quality Improvement; Healthcare Utilization; Clinical Decision Support; resource utilization

Outcome Measures

Primary Outcomes (1)

• Inappropriate Pill Days

  The study will take place within the existing UCLA Health Electronic Health Record (EHR) infrastructure. Data will be automatically collected from the EHR, focusing on pill days in excess of guidelines. The trial team will validate an eMeasure of inappropriate prescriptions as the primary outcome.

  12 months

Secondary Outcomes (4)

• Prescription Discontinuations

  12 months

• Prescription Refills

  12 months

• Overall Average Pill Days

  12 months

• GI Bleeding Hospitalization

  12 months

Study Arms (3)

Control

NO INTERVENTION

•Physicians use an unchanged prescribing workflow for Proton Pump Inhibitors (PPI) medications, with no changes to default dosage or duration.

Algorithmic Defaulting (Indication-Based Default)

EXPERIMENTAL

The Electronic Health Record (EHR) automatically evaluates whether the patient at hand meets guideline criteria for long-term vs. short-term Proton Pump Inhibitors (PPI) use and it selects a default PPI prescription duration. (Providers can override the defaulted duration if they disagree with the automated assessment.) The order panel displays each PPI option below one of the following duration choices: For short-term PPI, this includes patients with conditions like Gastroesophageal reflux disease (GERD). For long-term PPI, this includes patients with conditions requiring extended therapy (e.g. Barrett's esophagus, chronic NSAID use)

Behavioral: Algorithmic Defaulting (Indication-Based Default)

Active Physician Choice

EXPERIMENTAL

•The order panel displays each PPI option below one of the following duration choices: For short-term PPI, this includes patients with conditions like GERD. For long-term PPI, this includes patients with conditions requiring extended therapy (e.g. Barrett's esophagus, chronic NSAID use). The order panel removes the default selection, thus requiring providers to actively select a prescription duration for each patient, given the guideline education presented in the panel.

Behavioral: Active Physician Choice

Interventions

Algorithmic Defaulting (Indication-Based Default) BEHAVIORAL

PPIs are frequently overprescribed, and the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether modifying defaulted prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority.

Algorithmic Defaulting (Indication-Based Default)

Active Physician Choice BEHAVIORAL

PPIs are frequently overprescribed, and the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether requiring providers to actively select prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority.

Active Physician Choice

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• UCLA Health primary care physicians who have a clinical full-time equivalency of at least 25%.

You may not qualify if:

• Physicians with a clinical full-time equivalency of less than 25%

Sponsors & Collaborators

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

Study Sites (1)

UCLA Health System

Los Angeles, California, 90024, United States

RECRUITING

Central Study Contacts

Katelyn Clinical Research Coordinator

CONTACT

310-267-5250; katenguyen@mednet.ucla.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: CARE PROVIDER, INVESTIGATOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor of Medicine

Study Record Dates

• First Submitted: May 21, 2025
• First Posted: May 31, 2025
• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): June 1, 2027
• Last Updated: April 29, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)