# EHR nudges: Development and testing of a behavioral economics electronic health record module

> **NIH NIH R33** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2021 · $740,817

## Abstract

Project Summary
This study aims to leverage the power of behavioral economics with electronic health record technology to
promote appropriate diabetes care for older adults. Despite a variety of efforts, inappropriate care persists.
The ABIM Foundation’s Choosing Wisely Campaign identifies focus areas for improvement; one of ten
Choosing Wisely initiatives chosen by the American Geriatrics Society promotes less aggressive glycemic
targets and limited pharmacologic therapy for older adults with diabetes. Changing provider behavior,
however, is challenging, and existing information-based approaches fall short. Novel concepts from behavioral
economics, a field that blends insights from economics and psychology to recognize that humans make
predictable decision errors, have shown promise in a variety of healthcare settings. Incorporating such
approaches within the electronic health record (EHR) will allow seamless integration into clinical workflow with
minimal additional cognitive burden, and provide a mechanism for widespread scaling of effective
interventions. We propose to develop a behavioral economics-based EHR module to promote appropriate
clinical care of older adults with diabetes. Specific aims include: 1) To develop a scalable, EHR customization
toolkit that leverages behavioral economic insights (the BE-EHR module) to promote appropriate diabetes care
in older adults based on the American Geriatric Society’s Choosing Wisely guideline. We will implement a
user-centered design process to incorporate behavioral economic approaches into existing clinical decision
support tools and clinical workflows to design, iteratively refine, and usability test the new module. 2) To pilot
test the new BE-EHR module’s feasibility and acceptability and generate preliminary estimates of clinician
compliance with the Choosing Wisely guideline. We will conduct a 6-month, single-arm pilot study of the BE-
EHR module in 4 outpatient primary care and/or geriatrics clinics to measure utilization and feasibility, and to
estimate its impact on appropriate care delivery. 3) To test the ability of the BE-EHR module to reduce
inappropriate diabetes treatment among older adults. We will conduct an 18-month, rigorous, pragmatic,
cluster-randomized, controlled trial in 70 sites within the NYU Langone Medical Center ambulatory network to
determine the BE-EHR module’s impact on appropriate diabetes care among older adults. This proposal
combines a unique, experienced multi-disciplinary team with a ground-breaking approach to improve the care
of older Americans with diabetes.

## Key facts

- **NIH application ID:** 10249250
- **Project number:** 5R33AG057382-05
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Devin M Mann
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $740,817
- **Award type:** 5
- **Project period:** 2017-09-30 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10249250

## Citation

> US National Institutes of Health, RePORTER application 10249250, EHR nudges: Development and testing of a behavioral economics electronic health record module (5R33AG057382-05). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10249250. Licensed CC0.

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