Effect of an Automated Patient Dashboard Using Active Choice and Peer Comparison Performance Feedback to Physicians on Statin Prescribing : The PRESCRIBE Cluster Randomized Clinical Trial

Key Points

Question

Can an automated patient dashboard and nudges to physicians increase guideline-appropriate statin prescription rates among patients who were not previously receiving statin therapy?

Findings

In this cluster randomized clinical trial of 96 primary care physicians from 32 practice sites including 4774 patients, an automated patient dashboard using active choice framing and peer comparison feedback led to a modest but significant increase in guideline-appropriate statin prescribing rates compared with usual care.

Meaning

Nudges to physicians offer an effective, low-cost, and scalable approach to increase use of automated patient dashboards to improve guideline-concordant prescribing behaviors, but these approaches may need to be designed to better fit within clinician workflow or be combined with other approaches to further increase their impact.

Abstract

Importance

Statins are not prescribed to approximately 50% of patients who could benefit from them.

Objective

To evaluate the effectiveness of an automated patient dashboard using active choice framing with and without peer comparison feedback on performance to nudge primary care physicians (PCPs) to increase guideline-concordant statin prescribing.

Design, Setting, and Participants

This 3-arm cluster randomized clinical trial was conducted from February 21, 2017, to April 21, 2017, at 32 practice sites in Pennsylvania and New Jersey. Participants included 96 PCPs and 4774 patients not previously receiving statin therapy. Data were analyzed from April 25, 2017, to June 16, 2017.

Interventions

Primary care physicians in the 2 intervention arms were emailed a link to an automated online dashboard listing their patients who met national guidelines for statin therapy but had not been prescribed this medication. The dashboard included relevant patient information, and for each patient, PCPs were asked to make an active choice to prescribe atorvastatin, 20 mg, once daily, atorvastatin at another dose, or another statin or not prescribe a statin and select a reason. The dashboard was available for 2 months. In 1 intervention arm, the email to PCPs also included feedback on their statin prescribing rate compared with their peers. Primary care physicians in the usual care group received no interventions.

Main Outcomes and Measures

Statin prescription rates.

Results

Patients had a mean (SD) age of 62.4 (8.3) years and a mean (SD) 10-year atherosclerotic cardiovascular disease risk score of 13.6 (8.2); 2625 (55.0%) were male, 3040 (63.7%) were white, and 1318 (27.6%) were black. In the active choice arm, 16 of 32 PCPs (50.0%) accessed the patient dashboard, but only 2 of 32 (6.3%) signed statin prescription orders. In the active choice with peer comparison arm, 12 of 32 PCPs (37.5%) accessed the patient dashboard and 8 of 32 (25.0%) signed statin prescription orders. Statins were prescribed in 40 of 1566 patients (2.6%) in the usual care arm, 116 of 1743 (6.7%) in the active choice arm, and 117 of 1465 (8.0%) in the active choice with peer comparison arm. In the main adjusted model, compared with usual care, there was a significant increase in statin prescribing in the active choice with peer comparison arm (adjusted difference in percentage points, 5.8; 95% CI, 0.9-13.5; P = .008), but not in the active choice arm (adjusted difference in percentage points, 4.1; 95% CI, −0.8 to 13.1; P = .11).

Conclusions and Relevance

An automated patient dashboard using both active choice framing and peer comparison feedback led to a modest but significant increase in guideline-concordant statin prescribing rates.

Trial Registration

ClinicalTrials.gov Identifier: NCT03021759

Abstract

This 3-arm cluster randomized clinical trial evaluates the effectiveness of an automated patient dashboard using active choice framing with and without peer comparison feedback on performance to nudge primary care physicians to increase guideline-concordant statin prescribing.