{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T19:50:35Z","timestamp":1791661835523,"version":"4.3.4"},"reference-count":57,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R33AG057388"],"award-info":[{"award-number":["R33AG057388"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["P500PM_206728"],"award-info":[{"award-number":["P500PM_206728"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Interventions to reduce prescribing of high\u2010risk medications like benzodiazepines and sedative hypnotics to older adults have had modest success. Electronic health record (EHR)\u2010based alerts, especially those incorporating behavioral science, can improve prescribing but are under\u2010evaluated for deprescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In Novel Uses of adaptive Designs to Guide provider Engagement in Electronic Health Records (NUDGE\u2010EHR), we randomized primary care providers (PCPs) in a large healthcare system to usual care (no tool), 1 of 14 EHR tools (alerts with or without in\u2010basket messages) designed using behavioral science factors for patients \u2265\u200965\u2009years using long\u2010term benzodiazepines and sedative hypnotics, or standard EHR alert without factors. The alerts either triggered when PCPs initiated a patient encounter (\u201copen encounter\u201d) or placed medication orders (\u201corder entry\u201d); most contained one additional behavioral factor. Stage 1 tested all tools; the most promising were evaluated in Stage 2. The primary outcome was deprescribing (composite of PCP\u2010directed discontinuation or tapering) over follow\u2010up, measured using EHR data. We used generalized linear mixed models combining both stages and then among open encounter tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 216 randomized PCPs, 3063 patients were eligible (mean: 74.5 [SD: 7.2] years of age; 66.5% female). Stage 1 results selected open encounter timing, boostering (e.g., reinforcement), simplification, additional timing, and pre\u2010commitment behavioral science factors. Across both stages, 33.6% of usual care patients experienced deprescribing; unadjusted intervention group rates ranged from 25.9% to 45.1%. In primary models, none of the factors significantly increased the odds of deprescribing compared to arms not containing that factor. In secondary comparisons, open encounter timing was more effective than order entry (OR: 1.25, 95% CI: 1.01\u20131.56), and among open encounter tools, pre\u2010commitment significantly increased deprescribing (OR: 1.67, 95% CI: 1.00\u20132.87).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Incorporating most behavioral science principles into EHR alerts did not significantly improve deprescribing in older adults. However, alerts at encounter opening and patient\u2010focused pre\u2010commitment approaches may be more effective solutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT04284553\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19609","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T11:36:12Z","timestamp":1751628972000},"page":"3031-3043","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Comparing Fourteen Behavioral Science Electronic Health Record Deprescribing Tools in Older Adults:\n                    <scp>NUDGE<\/scp>\n                    \u2010\n                    <scp>EHR<\/scp>\n                    Adaptive Trial"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4940-4140","authenticated-orcid":false,"given":"Julie C.","family":"Lauffenburger","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Isaac","sequence":"additional","affiliation":[{"name":"Atrius Health  Newton Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Trippa","sequence":"additional","affiliation":[{"name":"Dana\u2010Farber Cancer Institute, Department of Biostatistics and Computational Biology and Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Glynn","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Russo","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punam","family":"Keller","sequence":"additional","affiliation":[{"name":"Tuck School of Business, Dartmouth College  Hanover New Hampshire 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