Pilot Trial of a Behavioral Economics-Informed Clinical Decision Support Alert to Improve Inpatient Tobacco Use Treatment Rates.

Introduction: Evidence-based tobacco use treatment (TUT) improves clinical outcomes, yet few clinicians initiate TUT for hospitalized patients who smoke. Clinical decision support (CDS) tools embedded in electronic health records (EHRs) offer opportunities to guide clinicians toward desired behaviors. CDS alerts informed by behavioral economics (BE-CDS) may increase TUT by presenting preselected orders and requiring justification to opt out.

Protocol for a type 3 hybrid implementation cluster randomized clinical trial to evaluate the effect of patient and clinician nudges to advance the use of genomic medicine across a diverse health system.

Background: Germline genetic testing is recommended for an increasing number of conditions with underlying genetic etiologies, the results of which impact medical management. However, genetic testing is underutilized in clinics due to system, clinician, and patient level barriers. Behavioral economics provides a framework to create implementation strategies, such as nudges, to address these multi-level barriers and increase the uptake of genetic testing for conditions where the results impact medical management.

A Pilot Study to Evaluate the Use of Automated Nicotine Metabolite Ratio Reporting Within Primary Care as an Implementation Strategy to Increase the Use of Tobacco Treatments.

Introduction: Concerns about safety and effectiveness of tobacco treatments reduce their use. We explored integrating the nicotine metabolite ratio (NMR), and messaging about its potential for improving safety and effectiveness, as a strategy to increase the use of tobacco treatments within primary care.

Aims And Methods: Through a prospective cohort design, we explored the effects of integrating NMR testing within primary care on the provision of tobacco treatment; 65 patients completed assessments including NMR before a clinic visit.

Behavioral Interventions to Improve Breast Cancer Screening Outreach: Two Randomized Clinical Trials.

Importance: Despite public health efforts, breast cancer screening rates remain below national goals.

Objective: To evaluate whether bulk ordering, text messaging, and clinician endorsement increase breast cancer screening rates.

Design, Setting, And Participants: Two concurrent, pragmatic, randomized clinical trials, each with a 2-by-2 factorial design, were conducted between October 25, 2021, and April 25, 2022, in 2 primary care regions of an academic health system.

Development of an Electronic Health Record-Based Clinical Decision Support Tool for Patients With Lynch Syndrome.

Purpose: To develop an electronic health record (EHR)-based clinical decision support (CDS) tool to promote guideline-recommended cancer risk management among patients with Lynch syndrome (LS), an inherited cancer syndrome that confers an increased risk of colorectal and other cancer types.

Materials And Methods: We conducted a cross-sectional study to determine the baseline prevalence and predictors of guideline-recommended colonic surveillance and annual genetics program visits among patients with LS. Multivariable log-binomial regressions estimated prevalence ratios (PRs) of cancer risk management adherence by baseline sociodemographic and clinical characteristics.

Impact of integrating genomic data into the electronic health record on genetics care delivery.

Purpose: Integrating genomic data into the electronic health record (EHR) is key for optimally delivering genomic medicine.

Methods: The PennChart Genomics Initiative (PGI) at the University of Pennsylvania is a multidisciplinary collaborative that has successfully linked orders and results from genetic testing laboratories with discrete genetic data in the EHR. We quantified the use of the genomic data within the EHR, performed a time study with genetic counselors, and conducted key informant interviews with PGI members to evaluate the effect of the PGI's efforts on genetics care delivery.

Rate and correlates of tobacco treatment during a primary care visit for a largely urban and African American sample of smokers.

Introduction: Evidence-based treatments for tobacco use are under-utilized and primary care visits may be an opportune time to address this gap. This study examined the rate at which primary care visits included tobacco use treatment and examined patient demographics, smoking characteristics, attitudes about tobacco use treatments, and comorbidities as correlates of treatment provision.

Methods: This prospective study assessed demographics, smoking characteristics, attitudes about tobacco use treatments, and comorbidities via interview prior to a primary care visit among 105 patients.

Effect of Targeted Messaging on Return to In-Person Visits During the COVID-19 Pandemic: A Randomized Clinical Trial.

This randomized clinical trial assess whether targeted messaging could improve the return to in-person visits during the COVID-19 pandemic.

Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial.

Objective: To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965.

Design: Pragmatic randomized controlled trial.

Setting: 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020.