Natural Experiment: "Gentle Nudge" Intervention, Eliminating Phone Call Requirement

NCT03381885 | Completed

• 1 other identifier: UCLA IRB#16-000932-002
• Study Type: interventional
• Target: 20,000
• Locations: 0 countries
• Sites: N/A

Brief Summary

Back pain costs the U.S. over $100 billion annually, and much of this spending is wasteful due to the overuse of advanced diagnostic imaging. Despite prominent clinical guidelines and the nationally recognized Choosing Wisely campaign discouraging use of costly and low value imaging, magnetic resonance imaging (MRI) and computed tomography (CT) studies remain frequently overused. Real-time electronic clinical decision support (CDS) at the point of care has been increasingly emphasized as an important strategy to improve the value of back pain management; however, studies suggest that CDS at best only modestly influences practice patterns. The aim is to implement a behavioral economic-based intervention in the ED to promote the use of CDS system.

Conditions

Back Pain; X-rays; MRI; CT Scan; Clinical Decision Support Tool

Outcome Measures

Primary Outcomes (1)

• Percentage of Unscored Imaging Orders

  Change in the percentage of Unscored Imaging Orders

  6 months from the date of intervention implementation

Secondary Outcomes (1)

• Percentage of Appropriate, Borderline and Inappropriate Imaging Orders

  6 months from the date of intervention implementation

Study Arms (2)

Intervention Group

EXPERIMENTAL

A "nudge" grounded in behavioral economic theory (nudge=gentle incentive, preserving freedom of choice)

Behavioral: Gentle Nudge

Control

PLACEBO COMPARATOR

No "nudge"

Behavioral: Usual Standard Procedure

Interventions

Gentle Nudge BEHAVIORAL

Clinicians ordering medium or high scoring imaging studies could bypass the usual mandatory phone call to radiology.

Intervention Group

Usual Standard Procedure BEHAVIORAL

Clinicians ordering imaging studies required mandatory phone to radiology

Control

Eligibility Criteria

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

You may qualify if:

• Adults with Lower Back Pain receiving treatment at Los Angeles Department of Health Services Facility (LAC-DHS)
• Adults whose physicians order Imaging Studies (CT SCANs and MRIs)

You may not qualify if:

• Non-LAC-DHS patients
• Patient without Lower Back Pain

Sponsors & Collaborators

• University of California, Los Angeles: lead
• LAC+USC Medical Center: collaborator
• Los Angeles Department of Health Services: collaborator
• American Board of Internal Medicine: collaborator

MeSH Terms

Conditions

Back Pain

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

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 in Residence

Study Record Dates

• First Submitted: October 12, 2017
• First Posted: December 22, 2017
• Study Start: February 1, 2015
• Primary Completion: January 1, 2016
• Study Completion: February 1, 2016
• Last Updated: December 22, 2017

Record last verified: 2017-12