Evidence map›Paper›PMID 34732478›Full record

ArticleBMJ open2021

Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic 'nudges' into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery.

Alast Ahmadi, Andrea Sorensen, Chad Wes A Villaflores, John N Mafi, Sitaram S Vangala, Ira S Hofer, John D Bartlett, Eric M Cheng, Victor F Duval, Cheryl Damberg and 9 more

Registry-linked trialOpen access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04104256 (Pragmatic Trial of an Electronic Health Record/Behavioral Economics Intervention to Reduce Pre-Operative Testing for Cataract Surgery), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.6field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04104256 nacompletednot on this map

Pragmatic Trial of an Electronic Health Record/Behavioral Economics Intervention to Reduce Pre-Operative Testing for Cataract Surgery

TypeinterventionalSponsorUniversity of California, Los AngelesRan2021 to 2023Enrolled1,045ConditionsPre-Operative Testing for Cataract SurgeryArmsNudge #1: Alert highlighting the safety/potential harms to patients of undergoing pre-op tests, Nudge #2: Alert highlighting the financial harms to the patient experiencing pre-op tests, Nudge #3: Alert highlighting potential psychological harms to the patient of experiencing pre-op tests, Usual Care
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 4 institutions in 1 country.

Alast AhmadiUniversity of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.ORCID 0000-0001-5841-0174
Andrea SorensenDivision of Geriatrics, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Chad Wes A VillafloresDivision of Geriatrics, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
John N MafiDivision of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.ORCID 0000-0002-0322-7636
Sitaram S VangalaDepartment of Medicine Statistics Core, Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Ira S HoferDepartment of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
John D BartlettDepartment of Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.ORCID 0000-0002-6172-7647
Eric M ChengDepartment of Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Victor F DuvalDepartment of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Cheryl DambergRAND Corp, Santa Monica, California, USA.
David ElashoffDepartment of Medicine Statistics Core, Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Noah J GoldsteinUniversity of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Joseph A LadapoDivision of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.ORCID 0000-0002-8518-4800
James M MooreDepartment of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Antonio M PessegueiroDivision of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Suzanne B ShuSC Johnson College of Business at Cornell University, Ithaca, New York, USA.
Samuel A SkootskyDivision of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Ashley TurnerPharmacogenomics, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Catherine A SarkisianDivision of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA csarkisian@mednet.ucla.edu.
University of California, Los Angeles · USCornell University · USMayo Clinic · USRAND Corporation · US

Funding

UCLA Clinical Translational Science InstituteUL1TR001881 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ARLEEN F. BROWN, ARASH NAEIM · 2016 to 2026
$118.1M
Identifying Approaches to Measure and Reduce Harmful, Low-Value Care Among Older Americans with Mild Cognitive Impairment and DementiaR01AG070017 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI MAFI, JOHN N. · 2021 to 2025
$2.6M
Midcareer Award in Patient-Oriented Community-Academic Partnered Aging ResearchK24AG047899 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SARKISIAN, CATHERINE A · 2014 to 2025
$2.0M
Pragmatic Trial of an Electronic Health Record/Behavioral Economics Intervention to Reduce Pre-operative Testing for Cataract SurgeryR01AG059815 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SARKISIAN, CATHERINE A · 2018 to 2021
$2.0M
Leveraging Electronic Health Records to Measure and Reduce Harmful, Low-Value Care Among Older AdultsK76AG064392 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI MAFI, JOHN · 2020 to 2024
$1.2M
NCATS NIH HHS UL1 TR001881NIA NIH HHS K24 AG047899NIA NIH HHS K76 AG064392NIA NIH HHS R01 AG059815NIA NIH HHS R01 AG070017
6 · The paper itself

Abstract

introductionRobust randomised trial data have shown that routine preoperative (pre-op) testing for cataract surgery patients is inappropriate. While guidelines have discouraged testing since 2002, cataract pre-op testing rates have remained unchanged since the 1990s. Given the challenges of reducing low-value care despite strong consensus around the evidence, innovative approaches are needed to promote high-value care. This trial evaluates the impact of an interdisciplinary electronic health record (EHR) intervention that is informed by behavioural economic theory. METHODS AND ANALYSIS: This pragmatic randomised trial is being conducted at UCLA Health between June 2021 and June 2022 with a 12-month follow-up period. We are randomising all UCLA Health physicians who perform pre-op visits during the study period to one of the three nudge arms or usual care. These three nudge alerts address (1) patient harm, (2) increased out-of-pocket costs for patients and (3) psychological harm to the patients related to pre-op testing. The nudges are triggered when a physician starts to order a pre-op test. We hypothesise that receipt of a nudge will be associated with reduced pre-op testing. The primary outcome will be the change in the percentage of patients undergoing pre-op testing at 12 months. Secondary outcomes will include the percentage of patients undergoing specific categories of pre-op tests (labs, EKGs, chest X-rays (CXRs)), the efficacy of each nudge, same-day surgery cancellations and cost savings. ETHICS AND DISSEMINATION: The study protocol was approved by the institutional review board of the University of California, Los Angeles as well as a nominated Data Safety Monitoring Board. If successful, we will have created a tool that can be disseminated rapidly to EHR vendors across the nation to reduce inappropriate testing for the most common low-risk surgical procedures in the country. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT04104256.

Indexed as

CataractCataract ExtractionEconomics, BehavioralElectronic Health RecordsHumansLow-Value CarePragmatic Clinical Trials as TopicRandomized Controlled Trials as Topicanaesthesia in ophthalmologycataract and refractive surgerygeriatric medicinehealth economicsquality in health care

Identifiers

PMID34732478
PMCPMC8572383
OpenAlexW3208845421

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.