Clinician Notification to Increase Aspirin Prophylaxis for Preeclampsia Prevention

This study is a pragmatic, cluster‐randomized implementation trial conducted across twomedical centers. The trial will evaluate whether clinician notification of elevatedpreeclampsia risk increases utilization of aspirin prophylaxis among eligible pregnantindividuals in routine outpatient obstetric care.Eligible encounters will include pregnant individuals receiving outpatient obstetric carewho are identified as having elevated risk for preeclampsia based on a clinical riskprediction model. Clusters, defined as outpatient obstetric clinics, care teams, orclinician groups, will be randomized to clinician notification or usual care.For encounters assigned to the intervention arm, clinicians will receive a notificationindicating that the patient is at elevated predicted risk for preeclampsia. Thenotification will recommend consideration of aspirin prophylaxis initiation between 12and 28 weeks' gestation when clinically appropriate and consistent with applicableclinical guidelines. The notification is intended to support clinician awareness andevidence‐based preventive care. It does not mandate aspirin use or assign patients toreceive aspirin.Encounters assigned to usual care will proceed according to existing clinical workflowswithout study‐generated clinician notification. The primary outcome will be aspirinprophylaxis utilization, defined by electronic health record evidence of aspirinprescription, active medication list entry, or documented clinician recommendation duringthe eligible gestational window.