Drink Less
Project status
Collaborators
Jeanmarie Perrone, MD
Samantha Huo, MD, MPH
Jeffrey Moon, MD, MPH
Margaret Lowenstein, MD, MSHP, MPhil
Nicole O'Donnell, CRS
Nikhil Mull, MD
Judy Chertok, MD
Natasa Rohacs
Ivan Covarrubias
Mei Ling Liu, MD
Innovation leads
Opportunity
Illness and death related to alcohol use have increased by 20 percent since the COVID-19 pandemic. During fiscal year 2021, Penn Medicine’s three downtown Philadelphia hospitals alone treated more than over 5,000 cases linked to alcohol use disorder (AUD) at a cost of $20 million.
Naltrexone is a safe, inexpensive medication that reduces alcohol use. However, despite its proven efficacy, it’s rarely prescribed in the emergency department (ED).
By enhancing medication prescribing practices for AUD, we can significantly reduce heavy drinking days, improve patient outcomes, and lower health care costs.
Intervention
Drink Less uses nudges deployed through the electronic health record (EHR) to help clinicians decide whether to prescribe naltrexone to patients with AUD and make the prescribing process easier. It also provides resources to facilitate communication between the clinician and patient about the medication.
We are piloting Drink Less nudges in two phases. In phase 1, we added naltrexone to the ED SmartSet and preference list, making the medication more accessible to clinicians in their workflow. We also developed an educational after-visit summary for patients to make naltrexone more approachable and aid with medication adherence.
During phase 2 we rolled out additional nudges to supplement the phase 1 interventions. We added AUD screening to the questions that patients are asked during triage. If the AUD screening is positive, a banner is displayed in the EHR to prompt the doctor or advanced practice provider to use the alcohol discharge SmartSet. We supply education to the clinicians via an AgileMD pathway and a counseling script so that they can feel better equipped to prescribe and discuss naltrexone.
Impact
We are monitoring usage of the AUD screener, motivational script, and discharge SmartSet, as well as the naltrexone prescription rate for AUD. Results will be posted when they become available.
Innovation Methods
Journey map
Journey map
We developed a detailed workflow capturing the journey of patients and clinicians in the emergency department to better understand decision and pain points. We discovered that a few different clinician roles were involved in care and the patient journey could vary based on their level of consumption.
Journey map
A journey map is a visualization of a user's process to accomplish a task. Journey mapping involves plotting user actions onto a timeline.
Details on users' thoughts, emotions, and feedback are then added to the timeline to provide a holistic view of the experience or journey. Journey mapping will help you uncover what's working well in the current state and identify key pain points that need addressing.
You can build a journey map based on several users' observations, creating an archetype user journey, or you can use a template in real time as you conduct individual observations of users.
Assumptions matrix
Assumptions matrix
We identified decision points throughout workflow that relied on assumptions to determine areas for further investigation. We found several assumptions that relied on clinician comfort with prescribing the medication and patient receptivity to treatment.
Assumptions matrix
An assumption is a statement about something that must be true for your solution to work.
When you have defined a solution you'd like to test, ask yourself, "What must be true for this to work?" Once you have a complete list, plot your assumptions on a 2x2 matrix where one axis is how certain you are that your assumption is accurate and the other is how detrimental it will be if it is not.
Mapping assumptions will help you determine what you need to test to de-risk a potential solution. Assumptions that you are uncertain about and that are crucial for your solution to work are your riskiest assumptions.
Fake front end
Fake front end
We developed mock-ups of study assets and conducted feedback sessions with key stakeholders to iterate. We uncovered that many clinicians lacked proper education on the medication and struggled to locate the medication in EPIC during the discharge process.