Pre-Operative Testing for Cataract Surgery Among Adults in LA County

NCT03253874 | Completed

• 1 other identifier: UCLA IRB #16-000932
• Study Type: interventional
• Target: 1,798
• Locations: 0 countries
• Sites: N/A

Brief Summary

A multi-disciplinary intervention will reduce inappropriate preoperative testing for cataract surgery. Despite multiple rigorous randomized controlled trials and meta-analyses showing that pre-operative testing for cataract surgery does not improve outcomes, pre-operative testing has not declined. A quality improvement initiative, which includes gaining senior leadership support, changing the culture of care, and elimination of pre-operative consultation visits for cataract surgery, to reduce inappropriate pre-operative testing. Quasi-experimental difference-in-difference analysis comparing the intervention arm (LAC+USC Medical Center) with the control arm (Harbor-UCLA Medical Center), 6 months prior and 6 months after the intervention. Generalized estimating equation models will adjust for age, gender, race/ethnicity, comorbidities and cluster by site.

Conditions

Cataract

Keywords

Pre-operative Testing; Cataract Surgery; Health Service Research; Low-Value Care; Safety-Net Hospital

Outcome Measures

Primary Outcomes (4)

• Inappropriate pre-operative testing (Clinical Labs)

  Electronic health records will be used to identify patients with a CPT (procedure) code for cataract surgery. Using CPT (procedure) codes for pre-preoperative clinical laboratory tests (Comprehensive Metabolic Panel, CBC Plate Diff). Using CPT (procedure) codes for pre-preoperative EKGs procedures. Using CPT (procedure) codes for pre-preoperative Chest X-rays. Using CPT (procedure) codes for pre-preoperative Provider Visits (LVN/RN/PA) Visits.

  1 year: 6 months prior to guideline implantation & 6 month after guideline implementation

• Inappropriate pre-operative testing (EKG)

  Electronic health records will be used to identify patients with a CPT (procedure) code for cataract surgery. Using CPT (procedure) codes for pre-preoperative EKGs procedures.

  1 year: 6 months prior to guideline implantation & 6 month after guideline implementation

• Inappropriate pre-operative testing (Chest X-rays)

  Electronic health records will be used to identify patients with a CPT (procedure) code for cataract surgery. Using CPT (procedure) codes for pre-preoperative Chest X-rays.

  1 year: 6 months prior to guideline implantation & 6 month after guideline implementation

• Inappropriate pre-operative testing (Provider Visits)

  Electronic health records will be used to identify patients with a CPT (procedure) code for cataract surgery. Using CPT (procedure) codes for pre-preoperative Provider Visits (LVN/RN/PA) Visits.

  1 year: 6 months prior to guideline implantation & 6 month after guideline implementation

Secondary Outcomes (2)

• Adverse post-operative events (e.g., arrhythmia, hyperkalemia, etc).

  1 year: 6 months prior to guideline implantation & 6 month after guideline implementation

• Time to Surgery

  1 year: 6 months prior to guideline implantation & 6 month after guideline implementation

Study Arms (2)

Intervention Site-LAC+USC Medical Center

EXPERIMENTAL

In this arm or study site,new guidelines are disseminated to all residents attending and faculty physicians within the department of Ophthalmology and Anesthesiology. New guidelines call for the across the board elimination of pre-operative testing and visits for patients undergoing cataract surgery.

Behavioral: No Pre-Op Testing for Cataract Surgeries

Control Site--Harbor-UCLA Medical Center

NO INTERVENTION

In this arm or study site, patients will undergo standard of care for cataract surgery without any new guidelines.

Interventions

No Pre-Op Testing for Cataract Surgeries BEHAVIORAL

Supported by the American Board of Internal Medicine's Choosing Wisely™ campaign to reduce low value care , the interventions aims to reduce pre-operative visits and testing for patients undergoing cataract surgeries.

Intervention Site-LAC+USC Medical Center

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Any DHS patient scheduled for cataract surgery over the 24 month time period

You may not qualify if:

• DHS patient who are not undergoing cataract surgery over the last 24 months period

Sponsors & Collaborators

• University of California, Los Angeles: lead
• Los Angeles County Department of Public Health: collaborator
• LAC+USC Medical Center: collaborator

MeSH Terms

Conditions

Cataract

Interventions

Cataract Extraction

Condition Hierarchy (Ancestors)

Lens Diseases; Eye Diseases

Intervention Hierarchy (Ancestors)

Refractive Surgical Procedures; Ophthalmologic Surgical Procedures; Surgical Procedures, Operative

Study Officials

• Catherine A. Sarkisian, MD, MSHS

  University of California, Los Angeles

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: November 15, 2016
• First Posted: August 18, 2017
• Study Start: October 1, 2014
• Primary Completion: April 1, 2016
• Study Completion: April 1, 2016
• Last Updated: August 18, 2017

Record last verified: 2017-08