EHR Alerts for Metabolic Syndrome
(SWAP-CKM Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
SWAP-CKM (SWitching to Appropriate Prescription in Cardiovascular-Kidney-Metabolic Syndrome) is a pragmatic, cluster-randomized clinical trial designed to evaluate whether electronic health record (EHR)-based alerts can improve medication prescribing among adults with cardiovascular, kidney, and metabolic (CKM) conditions.
The study will include all eligible adult patients receiving care within Kaiser Permanente Northern California (KPNC) who have CKM conditions and opportunities for therapeutic medication substitution. Fifteen service areas are randomly assigned to either an intervention group or a usual care group.
Clinicians in the intervention group will receive EHR-based Best Practice Advisories (BPAs) identifying opportunities to replace potentially inappropriate medications with guideline-recommended therapies. The intervention may also include audit-and-feedback reports to support medication optimization. Clinicians retain full discretion over treatment decisions.
The primary outcome is the proportion of eligible therapeutic optimization opportunities achieved at 9 months. Secondary outcomes include medication initiation and discontinuation, medication optimization at 18 months, and polypharmacy burden.
Who Is on the Research Team?
Ankeet S Bhatt, MD, MBA, ScM
Principal Investigator
Kaiser San Francisco Medical Center
Are You a Good Fit for This Trial?
This trial is for adults receiving care at Kaiser Permanente Northern California who have heart, kidney, or metabolic conditions like diabetes, chronic kidney disease, or heart failure. Participants must be eligible for possible changes to their current medications.Inclusion Criteria
Exclusion Criteria
What Are the Treatments Tested in This Trial?
Interventions
- Real-Time EHR Prompts and Audit-and-Feedback Reports
Trial Overview
The study tests whether electronic health record alerts and feedback reports given to doctors can help them switch patients with cardiovascular-kidney-metabolic issues to better guideline-recommended medicines compared to usual care.
How Is the Trial Designed?
2
Treatment groups
Experimental Treatment
Active Control
Clinicians in intervention service areas will receive electronic health record (EHR)-based OurPractice Advisories (OPAs) identifying opportunities to replace potentially inappropriate medications with guideline-recommended therapies. The advisories facilitate medication discontinuation and initiation through linked order sets while preserving clinician discretion. The intervention may also include audit-and-feedback reports identifying unfulfilled therapeutic optimization opportunities.
The usual care arm will receive standard clinical care without any study-related interventions. Providers will not receive visible OPA advisories, associated order sets, or study-specific audit-and-feedback reports, and routine care processes will remain unchanged. Control OPAs will operate silently for monitoring purposes without displaying recommendations to clinicians.
Find a Clinic Near You
Who Is Running the Clinical Trial?
Kaiser Permanente
Lead Sponsor
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