Trial study design
This study is an 18-month prospective randomized clinical trial for alerts and for notifications. Prescribers will be randomized to different types of alerts and/or notifications when a new or existing DOAC prescription is determined to not meet current evidence-based guidelines.For new inappropriate DOAC prescriptions during the study period: providers who write a new DOAC prescription that does not meet current evidence-based guidelines will be randomized at first instance with equal probability to one of two types of new prescription EHR alerts:• Alert style 1 will include information about why the prescription is inappropriate as well as recommendations for changing to an evidenced-based prescription.• Alert style 2 will also include this same information, but will also include a “button” that can be clicked to refer the prescription to a DOAC pharmacist for review.For existing DOAC prescriptions that are identified as inappropriate, prescribers will be randomized at first instance with equal probability to one of two routings for notifications:• Notification routing A will route to the prescriber to review the prescription and change it as appropriate.• Notification routing B will route directly to the DOAC pharmacist for review. The pharmacist may then opt to change the prescription themselves or consult with the prescriber about possible changes.Note that for our implementation strategies specified above, all four alerts and notifications make use of well-designed EHR alerts; alert style 2 and notification routing B augment this strategy with the encouragement of pharmacist-prescriber collaboration.Eligible prescribers may be randomized once per condition (alerts, notifications) during the 18-month study duration for alerts and for notifications, immediately following EHR identification of their first inappropriate new (for alerts) or existing (for notifications) DOAC prescription. Prescribers will continue to receive their assigned alert and/or notification type for subsequent inappropriate prescriptions for the duration of the trial. As such, while the trial for alerts and for notifications will be active for the trial in the Michigan Medicine EHR for a total of 18 months, prescribers will not be randomized or receive alerts/notifications until their first inappropriate prescription is identified. A waiver of documented informed consent was approved by the Michigan Medicine Institutional Review Board (IRB). Prescribers were notified prior to the alerts and notifications going live and can opt out at any time during the study period.