With the long term career goal of becoming a leading independent researcher transforming health information technology, Safiya I. Richardson, MD, MPH, proposes a mentored research project and specific career development plan which will prepare her to use behavioral science to develop effective clinical decision support (CDS). The disparity between usual and evidenced based clinical practice is responsible for a third of hospital deaths and waste estimated at 380 billon dollars each year. Computerized CDS has the potential to narrow this gap by bringing meaningful and relevant evidence to health care providers at the point of decision making. However, moderate improvements in care seen with CDS are significantly limited by consistently low provider adoption, estimated at 10%. This project uses behavioral theory and key principles of behavioral economics to illuminate and address barriers to provider adoption of CDS. Using the Capability Opportunity Motivation Behavior (COM-B) framework Dr. Richardson will examine barriers to provider adoption of a pulmonary embolism risk prediction CDS tool. The use of CDS to assess pre- test probability before computed tomography pulmonary angiography reduces testing by 25% without any missed pulmonary emboli. Routine use by providers would result in 600,000 fewer scans, 84,000 fewer cases of contrast induced nephropathy and prevent 3,000 malignancies as well as 2,000 cancer deaths in the United States every year. The overall objective of this training application is to develop and evaluate the feasibility and preliminary efficacy on provider adoption of a new tool that incorporates nudges designed to address barriers to tool use. Nudges are applications of behavioral science used by behavioral economists, defined as positive reinforcement and indirect suggestions which have a non-forced effect on decision making. The proposal aims to: 1) develop nudges designed to address identified behavioral barriers to adoption, 2) build and conduct iterative usability testing on prototypes of the new tool, 3) evaluate the feasibility and preliminary efficacy on provider adoption of the new tool compared to the current tool, in a pilot trial. This project uses a multistage mixed methods framework. It is the first to evaluate the impact of nudges on provider adoption of CDS. This research is complemented by career development activities, including formal training in health informatics, behavioral science, mixed methods and clinical trial design. With the guidance of an experienced mentoring team, the proposed research and training activities will lead to the development a competitive R01 grant application to assess the effectiveness of the new tool to improve health outcomes.
Computerized clinical decision support attempts to close the gap between usual and evidence based clinical practice by bringing relevant evidence to health care providers at the point of decision making, however, the moderate improvements in care seen with these tools have been significantly limited by consistently low provider adoption. This proposed study aims to use the principles of behavioral economics (i.e. the ?nudge?) in the development of a pulmonary embolism risk prediction clinical decision support tool to improve provider adoption. Increasing the adoption of clinical decision support tools will improve quality of care, decrease morbidity, mortality and health care waste.
