Key Information Can Influence Clinician Ordering of Brain CTs

NCT03449862 | Completed

• 1 other identifier: Pro00054122
• Study Type: interventional
• Target: 167
• Locations: 0 countries
• Sites: N/A

Brief Summary

The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems.

Conditions

Clinical Decision-Making

Outcome Measures

Primary Outcomes (1)

• brain CT medical image order

  At each decision point clinician asked to decide on which image to order for patient among three choices: * CT Head without/with contrast * CT Head without contrast * No medical imaging

  30 days

Study Arms (2)

LEGAL-COST

EXPERIMENTAL

Clinicians were first presented malpractice case law summary information (which suggests clinician not likely to be sued for not ordering CT scan) then patient out-of-pocket cost information for brain CT image (which provides them insight into what the patient is likely to pay for the test)

Other: Simulation-based clinical decision on brain CT ordering

COST-LEGAL

ACTIVE COMPARATOR

Clinicians were first presented with patient out-of-pocket cost information for brain CT image (which provides them insight into what the patient is likely to pay for the test) then malpractice case law summary information (which suggests clinician not likely to be sued for not ordering CT scan)

Other: Simulation-based clinical decision on brain CT ordering

Interventions

Simulation-based clinical decision on brain CT ordering OTHER

Clinicians asked to make decision on medical imaging for their simulated patient after presentation of clinical case then additional information. At each presentation of new information the clinician may modify their image order.

COST-LEGAL; LEGAL-COST

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Clinician (physician, nurse practitioner, physician assistant) licensed to deliver health care.
• Actively employed to deliver health care in the emergency department of Greenville health System (South Carolina) or Emory University (Georgia)

You may not qualify if:

• None

Sponsors & Collaborators

• Clemson University: lead
• Prisma Health-Upstate: collaborator
• Emory University: collaborator

Related Publications (1)

• Gimbel RW, Pirrallo RG, Lowe SC, Wright DW, Zhang L, Woo MJ, Fontelo P, Liu F, Connor Z. Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial. BMC Med Inform Decis Mak. 2018 Mar 12;18(1):20. doi: 10.1186/s12911-018-0602-1.

  PMID: 29530029 DERIVED

Study Officials

• Ronald W. Gimbel, PHD

  Clemson University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: Electronic web-based simulation study with built-in randomization tool
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Multi-center, double-blinded simulation-based randomized controlled trial

Study Record Dates

• First Submitted: February 14, 2018
• First Posted: February 28, 2018
• Study Start: August 31, 2016
• Primary Completion: April 11, 2017
• Study Completion: February 13, 2018
• Last Updated: February 28, 2018

Record last verified: 2018-02