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Related Experiment Video

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Application of Nudges to Design Clinical Decision Support Tools: Systematic Approach Guided by Implementation

Katy E Trinkley1,2,3,4, Danielle Maestas Duran3, Shelley Zhang1

  • 1Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Aurora, CO, 80045, United States, 1 3037246563.

Journal of Medical Internet Research
|September 25, 2025
PubMed
Summary
This summary is machine-generated.

This study presents a pragmatic approach using behavioral nudges to improve clinical decision support (CDS) tools, enhancing evidence-based practices and clinician satisfaction. The method integrates implementation science for effective CDS design and application.

Keywords:
behavioral economicsclinical decision support toolsheart failureimplementation sciencenudges

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Area of Science:

  • Health Informatics
  • Behavioral Economics
  • Implementation Science

Background:

  • Clinical decision support (CDS) tools aim to promote evidence-based practices but often yield mixed results and face clinician dissatisfaction.
  • Behavioral economics principles, specifically
  • nudges,
  • offer potential to enhance CDS effectiveness and user experience.
  • This paper addresses the need for a structured approach to integrate nudges into CDS.

Purpose of the Study:

  • To describe a systematic and pragmatic approach for identifying and prioritizing nudge integration into CDS tools.
  • To demonstrate the application of this approach through a case example of designing a CDS tool for heart failure medication prescribing.
  • To provide a framework for clinicians and informaticists to apply nudge theory in CDS development.

Main Methods:

  • Applied the Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments, and Ego (MINDS) nudge framework.
  • Utilized the Practical, Robust Implementation and Sustainability Model (PRISM) for implementation science.
  • Employed a four-step iterative process: partner engagement, nudge understanding, CDS format determination, and nudge prioritization.

Main Results:

  • A four-step iterative process, guided by PRISM, was defined for user-centered CDS design incorporating nudges.
  • The process facilitates systematic identification and prioritization of nudges to address contextual issues in CDS.
  • Illustrative examples from a heart failure prescribing case study detail the application and lessons learned.

Conclusions:

  • Presents a pragmatic, implementation science-informed approach for selecting and prioritizing nudges in CDS design.
  • Aims to optimize CDS effectiveness, clinician satisfaction, equity, and sustainability while minimizing unintended consequences.
  • This adaptable approach supports learning health systems in expediting evidence translation across various clinical settings.