# Reducing High Risk Polypharmacy Using Behavioral Economics through Electronic Health Records

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2023 · $428,196

## Abstract

Project Summary/Abstract
High-risk polypharmacy is common among older adults in the United States and is associated with harms such
as adverse drug reactions, falls, and higher costs of care. Individuals with cognitive impairment or dementia
may be at particularly at risk for adverse outcomes from polypharmacy. To date, efforts to reduce the rate of
high-risk polypharmacy have had limited uptake due to their expense per clinician and their modest
effectiveness in helping clinicians stop potentially inappropriate medications. These prior efforts have relied on
rational clinician behavior models. However, like people in general, clinicians are susceptible to irrational
biases and cognitive shortcuts that might perpetuate inappropriate high-risk polypharmacy. Therefore,
behavioral economic nudges, which do not assume rational decision making, might be well-positioned to
reduce such high-risk polypharmacy. Moreover, such nudges can be embedded in electronic health records
(EHRs), enhancing their scalability at a low cost per clinician—as long as they are acceptable to clinicians who
worry about EHRs’ effects on their workflows.
 The overall objectives of the project are to test EHR-based behavioral economic nudges that may
reduce the prevalence and degree of high-risk polypharmacy among older adult patients and to describe their
impact on clinicians’ experiences and workflows. The specific aims are (1) to evaluate the effects of an EHR-
based commitment nudge, a justification nudge, and the combination of both nudges on a composite measure
of high-risk polypharmacy in all older adults and the subpopulation with dementia or mild cognitive impairment
via a pragmatic randomized controlled trial. This will use cluster randomization in which primary care clinics
from two large health systems are randomized to receive 0, 1, or 2 nudges using a factorial design. The
nudges will run for 18 months, followed by 12 months of observation to assess persistence of effects; and (2)
to assess qualitatively and quantitatively clinician experiences with the EHR-based nudges, including their
acceptability and effects on workflow. At the conclusion of the intervention period, semi-structured interviews
with approximately 40 clinicians will be used to describe their experiences with the nudges in detail, and a
clinician survey will be conducted to examine the relationships between clinicians’ perceptions of the nudges,
their actual use of the EHR tools, and the relationships of these factors to actual changes in high-risk
polypharmacy. The study will yield EHR-based nudges that can be implemented across the country, detailed
descriptions of how these nudges affect clinicians’ workflows (to spur dissemination), and scientific papers
documenting the nudges’ effectiveness in reducing high-risk polypharmacy among older adults.

## Key facts

- **NIH application ID:** 10672251
- **Project number:** 5R01AG070054-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Stephen Persell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $428,196
- **Award type:** 5
- **Project period:** 2022-08-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10672251

## Citation

> US National Institutes of Health, RePORTER application 10672251, Reducing High Risk Polypharmacy Using Behavioral Economics through Electronic Health Records (5R01AG070054-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10672251. Licensed CC0.

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