Optimizing Proton Pump Inhibitors (PPI) Prescribing With EHR-Based Decision Support

Conditions

• Drug Utilization Review
• Physician's Practice Patterns
• Prescribing Patterns, Physician

Eligibility Criteria

Sex

ALL

Age

50 Years - N/A

Healthy Volunteers

Not accepted

Interventions

• Algorithmic Defaulting (Indication-Based Default) — BEHAVIORAL
  PPIs are frequently overprescribed, and the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether modifying defaulted prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority.
• Active Physician Choice — BEHAVIORAL
  PPIs are frequently overprescribed, and the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether requiring providers to actively select prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority.

Study Details

The proposed study is a quality improvement initiative designed to rigorously evaluate new variations of UCLA Health's proton pump inhibitor (PPI) order panels, building on internal quality improvement efforts to optimize prescribing workflows within the Electronic Health Record (EHR). PPIs are notoriously overprescribed, and the study team has identified that the CareConnect default prescription setting of 90 days with three refills (360 pill days) exceed standard guidelines (in most cases, 60 pill days). It is unclear whether this is the most appropriate workflow. Given that deprescribing PPIs carries minimal risk for most patients, this initiative will assess whether modifying defaulted prescription lengths influences prescribing behavior while ensuring physicians retain full decision-making authority. This evaluation of PPI order panel variations is embedded within UCLA's existing EHR system, ensuring that changes are tested pragmatically within routine workflows. The study aims to determine whether small adjustments to the order panel can better align prescribing patterns with clinical best practices while maintaining physician autonomy.

Key Dates

Start date

Jun 30, 2026

Status verified

Apr 2026

Primary completion

Apr 30, 2027

Completion

Jun 30, 2027

Study Design

Enrollment

372 participants (estimated)

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

HEALTH_SERVICES_RESEARCH

Arms

• No Intervention: Control
  •Physicians use an unchanged prescribing workflow for Proton Pump Inhibitors (PPI) medications, with no changes to default dosage or duration.
• Experimental: Algorithmic Defaulting (Indication-Based Default)
  The Electronic Health Record (EHR) automatically evaluates whether the patient at hand meets guideline criteria for long-term vs. short-term Proton Pump Inhibitors (PPI) use and it selects a default PPI prescription duration. (Providers can override the defaulted duration if they disagree with the automated assessment.) The order panel displays each PPI option below one of the following duration choices: For short-term PPI, this includes patients with conditions like Gastroesophageal reflux disease (GERD). For long-term PPI, this includes patients with conditions requiring extended therapy (e.g. Barrett's esophagus, chronic NSAID use)
• Experimental: Active Physician Choice
  •The order panel displays each PPI option below one of the following duration choices: For short-term PPI, this includes patients with conditions like GERD. For long-term PPI, this includes patients with conditions requiring extended therapy (e.g. Barrett's esophagus, chronic NSAID use). The order panel removes the default selection, thus requiring providers to actively select a prescription duration for each patient, given the guideline education presented in the panel.

Primary Outcome Measure

Inappropriate Pill Days [ Time Frame: 12 months ]

Central Contacts

• Katelyn Clinical Research Coordinator
  310-267-5250
  [email protected]

Locations (1)

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