Effect of Smartphone App–Based Education on Clinician Prescribing Habits in a Learning Health Care System

Abstract

IMPORTANCEEffective methods for engaging clinicians in continuing education for learning-based practice improvement remain unknown. OBJECTIVE To determine whether a smartphone-based app using spaced education with retrieval practice is an effective method to increase evidence-based practice. DESIGN, SETTING, AND PARTICIPANTSA prospective, unblinded, single-center, crossover randomized clinical trial was conducted at a single academic medical center from January 6 to April 24, 2020. Vanderbilt University Medical Center clinicians prescribing intravenous fluids were invited to participate in this study. INTERVENTIONSAll clinicians received two 4-week education modules: 1 on prescribing intravenous fluids and 1 on prescribing opioid and nonopioid medications (counterbalancing measure), over a 12-week period. The order of delivery was randomized 1:1 such that 1 group received the fluid management module first, followed by the pain management module after a 4-week break, and the other group received the pain management module first, followed by the fluid management module after a 4-week break. MAIN OUTCOMES AND MEASURESThe primary outcome was evidence-based clinician prescribing behavior concerning intravenous fluids in the inpatient setting and pain medication prescribing on discharge from the hospital. RESULTS A total of 354 participants were enrolled and randomized, with 177 in group 1 (fluid then pain management education) and 177 in group 2 (pain management then fluid education). During the overall study period, 16 868 questions were sent to 349 learners, with 11 783 (70.0%) being opened: 10 885 (92.4%) of those opened were answered and 7175 (65.9%) of those answered were answered correctly. The differences between groups changed significantly over time, indicated by the significant interaction between educational intervention and time (P = .002). Briefly, at baseline evidence-concordant IV fluid ordered 7.2% less frequently in group 1 than group 2 (95% CI, −19.2% to 4.9%). This was reversed after training at 4% higher (95% CI, −8.2% to 16.0%) in group 1 than group 2, a more than doubling in the odds of evidence-concordant ordering (OR, 2.56, 95% CI, 0.80-8.21). Postintervention, all gains had been reversed with less frequent ordering in group 1 than group 2 (−9.5%, 95% CI, −21.6% to 2.7%). There was no measurable change in opioid prescribing behaviors at any time point.

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform

“…Also, we did not assess whether our intervention led to meaningful changes in clinical practice, though research has previously demonstrated changes in clinical practice following spaced education interventions. [24][25][26][27] In this pilot study, we focused on the implementation and utility of the QuizTime platform for AMS education. Future efforts could focus on improving participation, assessing long-term impact, and scaling similar interventions to a broader population.…”

The Learning Sciences Meet the Learning Health System

“…The learning sciences field has empirically proven that certain strategies yield deeper and more durable learning, 2 yet these methods remain underused by medical students and physicians. 3 McEvoy et al 1 used 2 strategies that have the most evidence for enhancing learning: spaced education and retrieval practice. Retrieval practice is recalling information from memory (eg, quizzing through multiple-choice questions or flashcards) instead of rereading or rehearing content.…”

“…McEvoy et al used 2 strategies that have the most evidence for enhancing learning: spaced education and retrieval practice. Retrieval practice is recalling information from memory (eg, quizzing through multiple-choice questions or flashcards) instead of rereading or rehearing content.…”

“…The study by McEvoy et al is another application of learning sciences principles in the clinical setting. Although the intervention changed clinician behavior, the effect did not persist beyond 4 weeks.…”

“…McEvoy et al report the results of a single-center randomized cluster crossover trial using spaced education and retrieval practice with feedback to disseminate knowledge to clinicians at scale and measure the effect on prescribing patterns. After completing an app-based educational module with daily multiple-choice quiz questions over 4 weeks, clinicians were more likely to follow the evidence-based practice of prescribing balanced crystalloids rather than normal saline.…”