{
    "abstract": "Unnecessary testing and treatment of common conditions in older adults can lead to significant morbidity and mortality. The primary objective of this study was to develop and pilot test a set of clinical decision support (CDS) alerts informed by social psychology to address overuse in three areas related to ambulatory care of older adults.\nWe developed three electronic health record (EHR) CDS alerts to address overuse and pilot tested them from January 17, 2019 to July 17, 2019. We enrolled 14 primary care physicians from three practices within a large health system who cared for adults aged 65 years and older. Three measures of overuse applied to patients meeting the following criteria: ordering of prostate-specific antigen (PSA) for prostate cancer screening in adult men aged 76 years and older, ordering of urinalysis or urine cultures (UA or UC) for non-specific reasons to identify bacteriuria in women aged 65 years and older, and overtreatment of diabetes with insulin or oral hypoglycemic medications in adults aged at 75 years and older (DM). Clinicians received CDS alerts when criteria for any of the three overuse measures were met. We then surveyed clinicians to evaluate their experience with the CDS alerts.\nThe number of clinical encounters that triggered CDS alerts was 19 for PSA, 48 for UA/UC and 128 for DM. For PSA encounters, 4 (21%) orders were not performed after the alert. In the UA/UC encounters 29 (60%) orders were not performed after the alert. For the DM encounters, 21 (34%) had diabetes therapy reduced following the alert. Survey respondents indicated that the alerts were clinically accurate and sometimes led them to change their clinical action.\nThese CDS alerts were feasible to implement and may minimize unnecessary testing and treatment of common conditions in older adults.",
    "authors": [
        {
            "affiliation": "Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. Electronic address: trowe31@gmail.com.",
            "firstname": "Theresa A",
            "initials": "TA",
            "lastname": "Rowe"
        },
        {
            "affiliation": "Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.",
            "firstname": "Tiffany",
            "initials": "T",
            "lastname": "Brown"
        },
        {
            "affiliation": "Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.",
            "firstname": "Ji Young",
            "initials": "JY",
            "lastname": "Lee"
        },
        {
            "affiliation": "Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.",
            "firstname": "Jeffrey A",
            "initials": "JA",
            "lastname": "Linder"
        },
        {
            "affiliation": "Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States.",
            "firstname": "Daniella",
            "initials": "D",
            "lastname": "Meeker"
        },
        {
            "affiliation": "Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States.",
            "firstname": "Jason N",
            "initials": "JN",
            "lastname": "Doctor"
        },
        {
            "affiliation": "Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, United States.",
            "firstname": "Noah J",
            "initials": "NJ",
            "lastname": "Goldstein"
        },
        {
            "affiliation": "Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, United States.",
            "firstname": "Craig R",
            "initials": "CR",
            "lastname": "Fox"
        },
        {
            "affiliation": "Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.",
            "firstname": "Stephen D",
            "initials": "SD",
            "lastname": "Persell"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2022. Published by Elsevier B.V.",
    "doi": "10.1016/j.archger.2022.104794",
    "journal": "Archives of gerontology and geriatrics",
    "keywords": [
        "Behavioral economics",
        "Diabetes mellitus",
        "Electronic health records",
        "Overuse",
        "Prostate cancer screening",
        "Urinary tract infections"
    ],
    "methods": null,
    "publication_date": "2022-09-18",
    "pubmed_id": "36115068\n10535437\n31563924\n32128687\n26864410\n32047862\n27495917\n32933926\n34253672\n33992080\n17576283\n10087938\n32352478\n31078660\n18929686\n19297566\n29856886\n29049577\n32511720\n32885374\n24386447",
    "results": "The number of clinical encounters that triggered CDS alerts was 19 for PSA, 48 for UA/UC and 128 for DM. For PSA encounters, 4 (21%) orders were not performed after the alert. In the UA/UC encounters 29 (60%) orders were not performed after the alert. For the DM encounters, 21 (34%) had diabetes therapy reduced following the alert. Survey respondents indicated that the alerts were clinically accurate and sometimes led them to change their clinical action.",
    "title": "Development and pilot testing of EHR-nudges to reduce overuse in older primary care patients.",
    "xml": "<Element 'PubmedArticle' at 0x7885062599e0>"
}