Conclusions
Elton John, CIN
REGRESSION, TRANSFORMATION, CIN
The findings of this substudy support the implementation of using an EHR notification to both identify patients for clinical intervention—in this case, ACP—as well as for referral to a clinical study. This substudy highlights how the timing and repetition of the notification influence provider reception and actions. Additional research is needed to better understand how EHR notifications can be optimized for the provider user and improve overall implementation and adoption of EHR notifications for study referrals and ACP.We would like to thank Kimberly Leathers, Lauren Arnold, Lorrie Schmid, and Nikita Shah for their contribution to this project. The authors disclosed receipt of the following financial support for the research, authorship, and publication of this paper: The Meta-LARC ACP trial paper was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (PLC-1609-36277). The statements presented in the paper are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its Board of Governors or Methodology Committee. JEM’s effort was supported by the United States Department of Veterans Affairs Office of Academic Affiliation postdoctoral fellowship (TPH 21-000) and the Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (CIN 13-410). Both the Fellowship and Center are funded by the United States Department of Veterans Affairs, which had no involvement in data collection, analysis, and interpretation of results. Portions of this work have been presented at the 2020 Society of General Internal Medicine Annual Meeting, 2020 and 2021 Annual Assembly of American Academy of Hospice and Palliative Medicine, and 2022 Annual Assembly of American Academy of Hospice and Palliative Medicine: State of the Science as electronic poster presentations.Authors' Contributions: All authors contributed to the concept and design of this study; JEM and SI contributed to the acquisition of the data; JEM and RD designed and conducted the analysis; JEM, JL, CB, and RD drafted the paper; all authors revised it critically for important intellectual content, approved the version to be published, and participated sufficiently in the work for appropriate portions of the content.Conflicts of Interest: AK is an employee of Accompany Health; the employer had no role in the development or funding of this work. HBB reports research funding through his institution from BeBetter Therapeutics, Boehringer Ingelheim, Esperion, Improved Patient Outcomes, Merck, NHLBI, Novo Nordisk, Otsuka, Sanofi, VA. Elton John Foundation, Hilton Foundation, and Pfizer. He also provides consulting services for Abbott, Esperion, Imatar, Novartis, Sanofi, Vidya, Walmart, Webmed. He was also on the board of directors of Preventric Diagnostics.Logistic regression for number of notifications per patient and association with referral to study (N=2877).Unadjusted logistic regression among patients with electronic health record notification and without missing data and association of patient characteristics for referral to study (N=2802).