# Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE)

> **NIH NIH R33** · NORTHWESTERN UNIVERSITY · 2021 · $524,502

## Abstract

Project Summary
The risks and benefits of many diagnostic approaches and treatments differ for older adults compared to
middle aged adults. When diagnostic and therapeutic strategies are misapplied to older adults this can lead to
increased morbidity and mortality. Well-established examples where clinicians do not often follow best
practices in the care of older adults include those identified by the American Geriatrics Society for the
Choosing Wisely initiative: 1) testing and treatment for asymptomatic bacteriuria, 2) prostate specific antigen
testing in older men without prostate cancer, and 3) overuse of insulin or oral hypoglycemics for type 2
diabetes. There are several hypotheses as to why clinicians fail to incorporate best evidence into geriatric
clinical care. First, they may underestimate downstream harms of testing which seems easy to do (e.g., a
urinalysis for a non-specific symptom) or treatment that may be appropriate for younger patients (e.g.
intensifying insulin to achieve tight control). Second, clinicians may overweigh the risks of not performing
the action (e.g., missing cancer diagnosis, failing to diagnose UTI in a patient presenting without urinary tract
symptoms). Third, clinicians may respond to real or perceived social norms (from patients and their
families, other clinicians or both) that set expectations to behave in specific ways. Fourth, force of habit may
lead clinicians to act in a way similar to how they have done in the past even if current evidence doesn’t
support it. And fifth, clinicians may overuse a test or treatment to avoid feeling they are expressing an
ageist bias toward their patients. Clinical decision support nudges, informed by social psychology and
delivered via electronic health records (EHRs), are promising strategies to reduce the misuse of services in
cases where optimal utilization may not be zero but should be well below current practice. These interventions
seek to influence conscious and unconscious drivers of clinical decision making, are low cost to implement and
disseminate, and can be incorporated into existing delivery systems. In the R21 phase of the proposed
Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE) study, we will: select EHR-
delivered nudges to address 3 topics of potential misuse in older adults based on the main psychological
drivers of overuse identified in interviews with high-using clinicians; develop and pilot test decision support
tools within a health systems’ EHR to understand technical feasibility, work flow fit, preliminary impact on
clinical outcomes, and clinician acceptability; and develop and validate electronic clinical quality measures of
potential overuse/misuse related to the care of older adults. In the R33 phase we will: refine these approaches
and evaluate the effects of each nudge in a cluster randomized controlled trial conducted in over 40 clinical
sites across a large geographic region. We will measure the impact on clinical ...

## Key facts

- **NIH application ID:** 10249263
- **Project number:** 5R33AG057383-05
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Stephen Persell
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $524,502
- **Award type:** 5
- **Project period:** 2017-09-15 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10249263

## Citation

> US National Institutes of Health, RePORTER application 10249263, Behavioral Economics Applications to Geriatrics Leveraging EHRs (BEAGLE) (5R33AG057383-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10249263. Licensed CC0.

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