不到一半的新诊断的转移性非小细胞肺癌（NSCLC）患者接受了全面的分子检测。我们设计了一种基于电子病历（EMR）的“助推干预”，以在初次肿瘤内科咨询时提示进行基于血浆的分子检测。在宾夕法尼亚大学的学术实践和两个附属社区实践中进行了一项非随机前瞻性试验。通过基于组织和/或血浆的下一代测序方法进行分子基因分型。综合检测定义为 EGFR、ALK、BRAF、ROS1、MET、RET、KRAS 和 NTRK 检测。符合指南的治疗被定义为根据国家综合癌症网络 (NCCN) 指南使用适当的一线 (1L) 治疗。使用 Fisher 精确检验或 Pearson 卡方检验，比较干预前和干预后队列之间随时可获得全面分子基因分型结果的患者比例、1L 治疗前可获得的分子结果以及符合指南的 1L 治疗。其中包括 3 名患者，其中 376 名患者属于干预前队列，157 名患者属于干预后队列。实施基于 EMR 的助推后，与干预前队列相比，干预后队列中接受全面分子检测的患者比例更高（100% vs 88%，P = <.001），并且在开始 1L 治疗之前获得了全面分子检测结果(97.3% vs 91.6%，P = .026)，并接受了符合 NCCN 指南的护理 (89.8% vs 78.2%，P = .035)。在大型卫生系统的三个实践地点，实施了以提供者团队为中心的服务基于 EMR 的助推干预是可行的，并导致更多的 NSCLC 患者接受全面的分子基因分型。这些发现表明，行为推动可以促进分子检测，并且应该作为改善社区和学术场所指南一致护理的工具进行进一步研究。

Less than half of the patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) undergo comprehensive molecular testing. We designed an electronic medical record (EMR)-based "nudge intervention" to prompt plasma-based molecular testing at the time of initial medical oncology consultation.A nonrandomized prospective trial was conducted at the University of Pennsylvania's academic practice and two affiliated community practices. Molecular genotyping was performed by tissue- and/or plasma-based next generation sequencing methods. Comprehensive testing was defined as testing for EGFR, ALK, BRAF, ROS1, MET, RET, KRAS, and NTRK. Guideline-concordant treatment was defined as the use of the appropriate first-line (1L) therapy as per the National Comprehensive Cancer Network (NCCN) guidelines. Proportion of patients with comprehensive molecular genotyping results available at any time, molecular results available before 1L therapy, and guideline-concordant 1L treatment were compared between the preintervention and postintervention cohorts using Fisher's exact test or Pearson's chi-squared test.Five hundred and thirty-three patients were included, 376 in the preintervention cohort and 157 in the postintervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent comprehensive molecular testing in the postintervention versus the preintervention cohort (100% v 88%, P = <.001), had results of comprehensive molecular testing available before initiating 1L treatment (97.3% v 91.6%, P = .026), and received NCCN guideline-concordant care (89.8% v 78.2%, P = .035).Across three practice sites in a large health system, implementation of a provider team-focused EMR-based nudge intervention was feasible, and led to a higher number of patients with NSCLC undergoing comprehensive molecular genotyping. These findings demonstrate that behavioral nudges can promote molecular testing and should be studied further as a tool to improve guideline-concordant care in both community and academic sites.