Brief Summary

This pragmatic trial examines the uptake and effects of primary care clinician commitments to follow 3 Choosing Wisely® recommendations. The investigators hypothesize that pre-encounter invitations to clinicians to commit to the recommendations will decrease ordering of: (1) imaging tests for low back pain, (2) antibiotics for acute sinusitis, and (3) imaging tests for headaches. The study is a mixed-methods, stepped wedge cluster randomized trial in which the intervention will be sequentially introduced to 6 clinics in southeastern Michigan in a randomly assigned order.

Trial Health

On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment

participants targeted

Target at P25-P50 for not_applicable

Timeline

Completed

Started Sep 2014

Shorter than P25 for not_applicable

Geographic Reach

1 country

6 active sites

Status

completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

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Study Timeline

Key milestones and dates

9 months study duration

Study Start

First participant enrolled

September 1, 2014

Completed

17 days until next milestone

First Submitted

Initial submission to the registry

September 18, 2014

Completed

5 days until next milestone

First Posted

Study publicly available on registry

September 23, 2014

Completed

5 months until next milestone

Primary Completion

Last participant's last visit for primary outcome

March 1, 2015

Completed

3 months until next milestone

Study Completion

Last participant's last visit for all outcomes

June 1, 2015

Completed

Last Updated

May 6, 2016

Status Verified

May 1, 2016

Enrollment Period

6 months

First QC Date

September 18, 2014

Last Update Submit

May 5, 2016

Conditions

Health Services Misuse Physician's Practice Patterns Guideline Adherence Unnecessary Procedures Health Care Costs

Keywords

Costs and Cost AnalysisProfessional PracticeAttitude of Health PersonnelHealth Knowledge, Attitudes, and PracticeDecision MakingPractice Guidelines as TopicPhysician-Patient RelationsPhysician's RoleHealth CareQuality of Health CareQuality AssurancePhysicians, Primary CareEvidence-Based MedicineEvidence-Based PracticeDecision Support Systems, ClinicalReminder SystemsJudgmentCognitionPatient CareHealth Services MisuseUnnecessary ProceduresPrescribing Patterns, PhysicianInappropriate PrescribingOver PrescribingLow Back PainSinusitisInfections, Upper RespiratoryGeneralized HeadacheImaging, DiagnosticAntibioticsHumansOveruse of Low-Value ServicesPragmatic TrialStepped Wedge DesignCluster Randomized TrialChoosing Wisely

Outcome Measures

Primary Outcomes (1)

Composite rates of ordering 3 potentially low-value services in primary care visits by adult patients
Composite rates of ordering lumbar spine imaging tests in visits for low back pain, ordering antibiotics in visits for acute sinusitis, and ordering head imaging tests in visits for headaches.
Within 10 months of receiving the intervention

Secondary Outcomes (1)

Composite rates of ordering potential substitute services for 3 potentially low-value services in primary care visits by adult patients
Within 10 months of receiving the intervention

Study Arms (6)

Commitment invitation at time 1

EXPERIMENTAL

Intervention: Behavioral: Commitment Invitation In the stepped wedge cluster randomized design, the first clinic will remain in the control period (no intervention) for 2 months and then cross over to the intervention period for 6 months.