Purely educating doctors about the importance of prescribing certain therapies may not be enough to make a meaningful impact, according to a new Penn Medicine study. Using acid suppression therapy--an effective method of reducing the risk of gastrointestinal bleeding in vulnerable cardiac patients--Penn researchers tested interventions that utilized both education and an electronic "dashboard" system linked to patients' electronic medical records (EMRs) which gave doctors up-to-date information on which patients would likely benefit from the therapy. Researchers found that the education on acid suppression therapy alone did not have a noticeable effect on prescribing rates, but adding use of the dashboard resulted in an 18 percent increase in needed medication orders. The study was published this month in the Joint Commission Journal on Quality and Patient Safety.
"This study shows that education alone is typically not a sufficient method for changing the behavior of providers and care teams," said the study's senior author, Shivan Mehta, MD, MBA, associate chief innovation officer and an assistant professor of Medicine. "We demonstrated that although clinical leaders should collaborate to identify best practices, care redesign, technology, and behavior change strategies are also needed."
Acid suppression therapy involves prescribing patients with medications to reduce the level of acid in their stomach, which helps reduce heartburn symptoms and treat ulcers. It can also decrease some patients' risk of even developing ulcers, such as cardiac patients who are on certain medications that may increase their chance of bleeding.
"The main reason the patients are at risk is because they're placed on medications--or combinations of medications--such as anti-platelet agents or anticoagulation," said the study's lead author, Carolyn Newberry, MD, a Penn Medicine Gastroenterology fellow at the time the research was conducted who is currently an assistant professor of Medicine in the division of Gastroenterology and Hepatology at Weill Cornell Medicine in New York. "These medications are important for treating or preventing cardiovascular disease but they also have side effects such as increased bleeding in the G.I. tract."
Before the study's EMR-linked dashboard was developed and implemented, through help from Penn Medicine's Center for Health Care Innovation, prescription rates for cardiac patients who could benefit from acid suppression therapy was just shy of 73 percent, according to the health system's data of inpatients in the Cardiac Intensive Care Unit (CICU) from September 2016 and January 2017. Afterward, from January until September 2017 when the "dashboard" was implemented, rates quickly jumped to 86 percent for patients in the CICU.
Great gains were made using this type of technology-assisted nudge, which the study team notes could improve desired outcomes in other clinical areas. Software developers at the Center for Health Care Innovation are working on similar dashboards or alerts in many other clinical areas where there is an opportunity to increase adoption of evidence-based practices. However, the researchers emphasized that this "nudge" approach is not one size fits all.
"No one dashboard or technology will work in every area, so it is important to partner with clinicians and identify workflows and processes where it can complement care," Newberry said. "Our experience highlights this individualized nature and the importance of continued collaboration, along with process redesigns, to achieve sustainable success."
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Other Penn authors on this study include Shazia Siddique, David Metz, Christopher Domenico, Katherine Choi, and Eugene Gitelman.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $7.8 billion enterprise.
The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $405 million awarded in the 2017 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine, and Princeton House Behavioral Health, a leading provider of highly skilled and compassionate behavioral healthcare.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2017, Penn Medicine provided more than $500 million to benefit our community.
Journal
The Joint Commission Journal on Quality and Patient Safety