Behavioral Economics Interventions in Clinical Decision Support Systems

Cho, Insook; Bates, David W.

doi:10.1055/s-0038-1641221

Cited by 32 publications

(30 citation statements)

References 75 publications

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“…In health care, choice architecture can help clarify options in a way that avoids biases and improves the quality of decision making. 6 Nudges are appropriate to steer a patient away from a harmful choice or toward a beneficial choice, such as vaccination or life-saving antibiotics, but it is never ethical to use lies and deception or to explicitly undermine a person's right to self-determination. Crisis pregnancy centers don't use nudges; they lie.…”

Section: Choice Architecture and Timingmentioning

confidence: 99%

Ethical Choice Architecture in Preabortion Counseling

Westbrook

2020

AMA Journal of Ethics

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Most women requesting pregnancy termination have already decided to undergo an abortion. Physicians are required to obtain informed consent after offering objective and accurate descriptions of abortion and its risks and benefits. Some jurisdictions also require concurrent counseling and ultrasound viewing. This article discusses potential benefits and harms of providing emotionally charged or biased content about abortions at the time of service, considers what constitutes ethical content, and explores when ethical content should be part of abortion decision making. Unplanned Pregnancy After Roe v Wade "I'm pregnant." These 2 words can mean, among other things, delight or disaster for a woman. An unexpected pregnancy can be a source of joy, but an unexpected pregnancy can be devastating when it threatens a woman's life, her social standing, her career, her marriage, or her future. Before 1973, a woman with an unwanted pregnancy was legally obligated to carry it to term in most states, either keeping the baby or giving it up for adoption. Illegal abortions were a third and dangerous option. 1 The pregnancy choice landscape changed dramatically with Roe v Wade in 1973, 2 when safe, legal abortion became a realistic option. Ironically, for some, choice made facing an unexpected pregnancy even more difficult. Even today, whether to continue a pregnancy is one of the most difficult decisions a pregnant woman will ever have to make. To help her decide, she might look for advice and support from a friend, a family member, the baby's father, or a trusted cleric, but rarely will she consult a physician. Pregnancy counseling services came into existence when women's rights gained momentum in the 1970s. As individual states legalized abortion, abortion services incorporated counseling to help women make an informed choice. 3 Clinicians in stateregulated practices, such as Planned Parenthood, were expected to adhere to professional standards and ethical guidelines, as explicitly stated by a number of professional medical organizations 4 ; provide comprehensive and unbiased information;

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Section: Choice Architecture and Timingmentioning

confidence: 99%

Ethical Choice Architecture in Preabortion Counseling

Westbrook

2020

AMA Journal of Ethics

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“…[5] In addition, the rising eld of behavioral economics explores how different interventions, such as nudges or best-practice-alerts (BPA), in uence and improve clinical decision making through various applicable concepts. [6,7] The goal of this study is to understand the economic impact of EHR based CDS interventions and to identify a coherent research best practice approach for these clinical interventions from a cost outcome perspective. Finally, we seek to examine application areas for different medical risk factors that have meanwhile been explored to be cost-saving or cost-effective.…”

Section: Introductionmentioning

confidence: 99%

Economic Impact of Clinical Decision Support Interventions Based on Electronic Health Records

Lewkowicz

Wohlbrandt

Boettinger

2020

Preprint

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BackgroundUnnecessary healthcare utilization, non-adherence to current clinical guidelines or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to increase quality of care and thereby yield substantial effects onreducing healthcare expenditure. Inthis articleweevaluate the economic impact of clinical decision support (CDS) interventions which are based on electronic health records (EHR).MethodsWe searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registrydatabases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practiceapplication areas and categorized the investigated interventions according to an existing taxonomy of front-endCDS tools. Results and discussionTwenty-sevenstudies are investigated in this review. Of those, twenty-twostudies indicate a reduction of healthcare expenditure after implementingan EHRbased CDS system, especiallytowardsprevalent application areas, such as unnecessarylaboratory testing, duplicate order entry, efficient transfusion practice or reduction of antibiotic prescriptions.On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance cost of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance for further high quality economic evaluations for these CDS systems. ConclusionCurrent research studies lack to consider comparative cost-outcome metrics as well as detailed cost-components in their analyses. Nonetheless, thepositive economic impact of EHR based CDS interventions especially with regard to reducing waste in healthcare is highly promising.

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“…[5] In addition, the growing eld of behavioral economics explores how different interventions, such as nudges or best-practice-alerts (BPA), in uence and improve clinical decision making through various applicable concepts. [6,7] The goal of this study is to explore the economic impact of EHR based CDS interventions and to identify a coherent best practice approach for these clinical interventions from a cost outcome perspective. Finally, we seek to examine cost-saving or cost-effective application areas for different medical risk factors.…”

Section: Introductionmentioning

confidence: 99%

Economic impact of clinical decision support interventions based on electronic health records

Lewkowicz

Wohlbrandt

Boettinger

2020

Preprint

View full text Add to dashboard Cite

Background Unnecessary healthcare utilization, non-adherence to current clinical guidelines, or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to improve quality of care and thereby yield substantial effects on reducing healthcare expenditure. In this article, we evaluate the economic impact of clinical decision support (CDS) interventions based on electronic health records (EHR).Methods We searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registry databases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practice application areas and categorized the investigated interventions according to an existing taxonomy of front-end CDS tools. Results and discussion Twenty-seven studies are investigated in this review. Of those, twenty-two studies indicate a reduction of healthcare expenditure after implementing an EHR based CDS system, especially towards prevalent application areas, such as unnecessary laboratory testing, duplicate order entry, efficient transfusion practice, or reduction of antibiotic prescriptions. On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance costs of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance of further high-quality economic evaluations for these CDS systems. Conclusion Current research studies lack consideration of comparative cost-outcome metrics as well as detailed cost components in their analyses. Nonetheless, the positive economic impact of EHR based CDS interventions is highly promising, especially with regard to reducing waste in healthcare.

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Behavioral Economics Interventions in Clinical Decision Support Systems

Cited by 32 publications

References 75 publications

Ethical Choice Architecture in Preabortion Counseling

Ethical Choice Architecture in Preabortion Counseling

Economic Impact of Clinical Decision Support Interventions Based on Electronic Health Records

Economic impact of clinical decision support interventions based on electronic health records

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