{"doi":"10.1001/jamanetworkopen.2024.32760","title":"Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care","abstract":"<jats:sec id=\"ab-zoi240987-4\">\n                    <jats:title>Importance</jats:title>\n                    <jats:p>Nudges have been increasingly studied as a tool for facilitating behavior change and may represent a novel way to modify the electronic health record (EHR) to encourage evidence-based care.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-5\">\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To evaluate the association between EHR nudges and health care outcomes in primary care settings and describe implementation facilitators and barriers.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-6\">\n                    <jats:title>Evidence Review</jats:title>\n                    <jats:p>On June 9, 2023, an electronic search was performed in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for all articles about clinician-facing EHR nudges. After reviewing titles, abstracts, and full texts, the present review was restricted to articles that used a randomized clinical trial (RCT) design, focused on primary care settings, and evaluated the association between EHR nudges and health care quality and patient outcome measures. Two reviewers abstracted the following elements: country, targeted clinician types, medical conditions studied, length of evaluation period, study design, sample size, intervention conditions, nudge mechanisms, implementation facilitators and barriers encountered, and major findings. The findings were qualitatively reported by type of health care quality and patient outcome and type of primary care condition targeted. The Risk of Bias 2.0 tool was adapted to evaluate the studies based on RCT design (cluster, parallel, crossover). Studies were scored from 0 to 5 points, with higher scores indicating lower risk of bias.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-7\">\n                    <jats:title>Findings</jats:title>\n                    <jats:p>Fifty-four studies met the inclusion criteria. Overall, most studies (79.6%) were assessed to have a moderate risk of bias. Most or all descriptive (eg, documentation patterns) (30 of 38) or patient-centeredness measures (4 of 4) had positive associations with EHR nudges. As for other measures of health care quality and patient outcomes, few had positive associations between EHR nudges and patient safety (4 of 12), effectiveness (19 of 48), efficiency (0 of 4), patient-reported outcomes (0 of 3), patient adherence (1 of 2), or clinical outcome measures (1 of 7).</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-8\">\n                    <jats:title>Conclusions and Relevance</jats:title>\n                    <jats:p>This systematic review found low- and moderate-quality evidence that suggested that EHR nudges were associated with improved descriptive measures (eg, documentation patterns). Meanwhile, it was unclear whether EHR nudges were associated with improvements in other areas of health care quality, such as effectiveness and patient safety outcomes. Future research is needed using longer evaluation periods, a broader range of primary care conditions, and in deimplementation contexts.</jats:p>\n                  </jats:sec>","journal":"JAMA Network Open","year":2024,"id":626491,"datarank":0.4943755299006494,"base_score":3.295836866004329,"endowment":3.295836866004329,"self_citation_contribution":0.4943755299006494,"citation_network_contribution":0.0,"self_endowment_contribution":0.4943755299006494,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":26,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1620598,"name":"Avaneesh R. Kunta","orcid":null,"position":1,"is_corresponding":false},{"id":1188070,"name":"Sri Varsha Katoju","orcid":null,"position":2,"is_corresponding":false},{"id":1620599,"name":"Sara Gheytasvand","orcid":null,"position":3,"is_corresponding":false},{"id":1620600,"name":"Niloofar Masoumi","orcid":null,"position":4,"is_corresponding":false},{"id":1620601,"name":"Ronia Tavasolian","orcid":null,"position":5,"is_corresponding":false},{"id":799844,"name":"Amir Alishahi Tabriz","orcid":"0000-0002-6273-9105","position":6,"is_corresponding":false},{"id":1620602,"name":"Young-Rock Hong","orcid":null,"position":7,"is_corresponding":false},{"id":1147592,"name":"Karim Hanna","orcid":"0000-0002-2194-8875","position":8,"is_corresponding":false},{"id":1620603,"name":"Randa Perkins","orcid":null,"position":9,"is_corresponding":false},{"id":1147593,"name":"Arpan Parekh","orcid":"0000-0002-7896-8949","position":10,"is_corresponding":false},{"id":603539,"name":"Kea Turner","orcid":"0000-0002-7885-0879","position":11,"is_corresponding":false},{"id":1147591,"name":"Oliver T. Nguyen","orcid":"0000-0003-2852-7106","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care","abstract":"<jats:sec id=\"ab-zoi240987-4\">\n                    <jats:title>Importance</jats:title>\n                    <jats:p>Nudges have been increasingly studied as a tool for facilitating behavior change and may represent a novel way to modify the electronic health record (EHR) to encourage evidence-based care.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-5\">\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To evaluate the association between EHR nudges and health care outcomes in primary care settings and describe implementation facilitators and barriers.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-6\">\n                    <jats:title>Evidence Review</jats:title>\n                    <jats:p>On June 9, 2023, an electronic search was performed in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for all articles about clinician-facing EHR nudges. After reviewing titles, abstracts, and full texts, the present review was restricted to articles that used a randomized clinical trial (RCT) design, focused on primary care settings, and evaluated the association between EHR nudges and health care quality and patient outcome measures. Two reviewers abstracted the following elements: country, targeted clinician types, medical conditions studied, length of evaluation period, study design, sample size, intervention conditions, nudge mechanisms, implementation facilitators and barriers encountered, and major findings. The findings were qualitatively reported by type of health care quality and patient outcome and type of primary care condition targeted. The Risk of Bias 2.0 tool was adapted to evaluate the studies based on RCT design (cluster, parallel, crossover). Studies were scored from 0 to 5 points, with higher scores indicating lower risk of bias.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-7\">\n                    <jats:title>Findings</jats:title>\n                    <jats:p>Fifty-four studies met the inclusion criteria. Overall, most studies (79.6%) were assessed to have a moderate risk of bias. Most or all descriptive (eg, documentation patterns) (30 of 38) or patient-centeredness measures (4 of 4) had positive associations with EHR nudges. As for other measures of health care quality and patient outcomes, few had positive associations between EHR nudges and patient safety (4 of 12), effectiveness (19 of 48), efficiency (0 of 4), patient-reported outcomes (0 of 3), patient adherence (1 of 2), or clinical outcome measures (1 of 7).</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-zoi240987-8\">\n                    <jats:title>Conclusions and Relevance</jats:title>\n                    <jats:p>This systematic review found low- and moderate-quality evidence that suggested that EHR nudges were associated with improved descriptive measures (eg, documentation patterns). Meanwhile, it was unclear whether EHR nudges were associated with improvements in other areas of health care quality, such as effectiveness and patient safety outcomes. Future research is needed using longer evaluation periods, a broader range of primary care conditions, and in deimplementation contexts.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":3.258096538021482,"endowment":3.258096538021482,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"39287947","pmcid":"PMC11409160","openalex_id":"https://openalex.org/W4402555929","authors":[],"funders":[],"total_grants":0,"fwci":13.6035,"citation_percentile":0.984522,"influential_citations":0,"citation_trend":[{"year":2024,"count":1},{"year":2025,"count":13},{"year":2026,"count":11}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2823608/nguyen_2024_oi_240987_1725552386.35032.pdf","host_type":"journal"},{"url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2823608/nguyen_2024_oi_240987_1725552386.35032.pdf","host_type":"publisher"},{"url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2823608/nguyen_2024_oi_240987_1768490669.46005.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1001/jamanetworkopen.2024.32760","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/39287947","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11409160","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/instance/11409160/bin/jamanetwopen-e2432760-s001.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11409160","host_type":"Europe_PMC"}],"fields_of_study":["Electronic Health Records Systems","Health Policy Implementation Science","Nursing Diagnosis and Documentation","Primary Health Care","Humans","Electronic Health Records","Quality of Health Care","Outcome Assessment, Health Care"],"mesh_terms":["Humans","Primary Health Care","Quality of Health Care","Outcome Assessment, Health Care","Electronic Health Records"],"keywords":["CINAHL","PsycINFO","MEDLINE","Medicine","Randomized controlled trial","Nudge theory","Health care","Family medicine","Documentation","Research design","Nursing","Psychology","Psychological intervention"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Reduced inequalities"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-04T14:06:01.673533Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}