Brief Summary

Clinicians' decisions to order potentially unnecessary services -- such as those targeted in the Choosing Wisely® campaign -- are often affected by their high-pressure practice environments, which can make it hard to consistently avoid ordering low-value care. The field of behavioral economics offers a promising and highly scalable approach to decreasing use of low-value services: asking clinicians to commit to avoid ordering such services and providing them and their patients with resources to support adherence to this commitment. This project will evaluate the effects of such an intervention across 2 large health systems, Michigan Medicine and IHA, through a mixed-methods, stepped wedge cluster randomized trial. In each of the study clinics, clinicians will be invited to commit to following a set of targeted Choosing Wisely® recommendations. Clinicians who make such a commitment, and their patients, will receive access to key resources to support adherence to this commitment. To measure the effects of the intervention, automated clinical data and medical record data before and after the intervention will be examined. Surveys and semi-structured interviews of both clinicians and patients will also be conducted to determine the effects of the intervention on their decision-making and experiences.

Trial Health

On Track

Trial Health Score

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

Enrollment

489

participants targeted

Target at P75+ for not_applicable

Timeline

Completed

Started Jan 2018

Geographic Reach

1 country

9 active sites

Status

completed

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

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

1.1 years study duration

First Submitted

Initial submission to the registry

January 19, 2018

Completed

7 days until next milestone

First Posted

Study publicly available on registry

January 26, 2018

Completed

Same day until next milestone

Study Start

First participant enrolled

January 26, 2018

Completed

9 months until next milestone

Primary Completion

Last participant's last visit for primary outcome

November 1, 2018

Completed

4 months until next milestone

Study Completion

Last participant's last visit for all outcomes

February 28, 2019

Completed

Last Updated

March 7, 2019

Status Verified

March 1, 2019

Enrollment Period

9 months

First QC Date

January 19, 2018

Last Update Submit

March 5, 2019

Conditions

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

Outcome Measures

Primary Outcomes (1)

Difference in the proportion of intervention and control period visits with an applicable low-value treatment or test as specified by each respective Choosing Wisely® recommendation
The applicable low-value treatments or tests specified by the respective Choosing Wisely® recommendations are use of hypoglycemic medications for patients 65 years or older with diabetes and tight glycemic control, PSA testing among men 75 years or older with no history of prostate cancer, and use of benzodiazepine or sedative-hypnotic medications for patients with insomnia or anxiety who are 65 years or older.
10 months

Secondary Outcomes (4)

Patient trust in primary care provider
Within 1 week of primary care visit
Patient rating of provider
Within 1 week of primary care visit
Frequency of patient-provider conversations about the applicable low-value treatments or tests
Within 1 week of primary care visit
Composite difference in the proportion of intervention and control period visits with an applicable low-value treatment or test as specified by each respective Choosing Wisely® recommendation
10 months

Study Arms (8)

Commitment invitation at time 1

EXPERIMENTAL

In the stepped wedge cluster randomized design, the first clinic will remain in the control period (no intervention) for 1 month, followed by a 1 month transition period (where data will not be collected), before crossing over to the intervention period for 8 months.