Assessing Opioid Care Practices Using CPV Patient Simulation Modules

NCT04080037 | Completed

• 1 other identifier: 01-QALM-2019
• Study Type: interventional
• Target: 220
• Locations: 1 country
• Sites: 1

Brief Summary

This study will test the quality of opioid-related physician care decisions using a patient-simulation based measurement and feedback approach that combines multiple-choice care decisions with real-time, personalized scoring and feedback. The cases and feedback have been designed to align with the latest CDC opioid guidelines. The study will also measure the impact of gaming-inspired competition and motivation, including a weekly leaderboard, to improve evidence-based care decisions. The quality of care decisions will be measured in the simulations and in a multiple-choice assessment administered before and after the patient simulations.

Conditions

Pain; Pain, Acute; Pain, Chronic; Pain, Neuropathic; Opioid-use Disorder; Opioid Abuse and Addiction; Opioid Withdrawal

Outcome Measures

Primary Outcomes (2)

• Change in provider scores on pre- and post-intervention assessments

  At the beginning and end of the study, participants with complete a 20 multiple-choice question assessment to measure familiarity with the latest CDC opioid guidelines. The assessment scales are known as the "QURE-Ascend Learning Modules: Opioids, Assessment A" and "QURE-Ascend Learning Modules: Opioids, Assessment B," both of which measure familiarity with the latest CDC guidelines via multiple-choice questions. Scores on the scales range from 0 to 100%, with a higher score representing greater familiarity with evidence-based care. There are no subscales within the measures. Between the assessment, they will care for online simulated patients and receive feedback on their care decisions. A primary outcome in the study will be to measure whether performance on the assessments improves after caring for the simulated patients and receiving feedback. Higher scores on the second assessment represent a better outcome.

  2 months

• Change in the overall and the diagnostic and treatment quality scores in the CPV QualityIQ patient simulations.

  In each case, participants will answer multiple-choice questions about their preferred course of action to work-up, diagnose and treat patients in the primary care setting. Each question has specific evidence-based scoring criteria identifying necessary and unnecessary care decisions. Each provider will get a score for each case, ranging from 0 to 100 percentage based on the care decisions they make in the case. Over the course of the project, the investigators will track the percentage of correct, evidence-based care decisions made by participants, with the hypothesis that serial measurement and feedback on evidence-based care decisions will lead to increases in appropriate decisions over time. Higher scores represent a better outcome.

  2 months

Secondary Outcomes (2)

• Participant satisfaction as measured by post-evaluation survey

  2 months

• Physician engagement throughout the study

  2 months

Study Arms (1)

Study Participants

EXPERIMENTAL

All eligible and consented participants will be asked complete a multiple-choice opioid assessment based on the latest CDC opioid guidelines, then care for 6 online QualityIQ patient simulations and receive feedback on their care decisions. They will then all complete an other multiple-choice assessment at the conclusion of the study.

Other: Quality IQ Patient Simulations

Interventions

Quality IQ Patient Simulations OTHER

Online patient cases designed to simulate typical patients seen in a primary care practice. In each case, providers will answer multiple-choice questions about their preferred course of action to work-up, diagnose and treat patients in the primary care setting. After each question, providers will receive evidence-based feedback, including references, on the appropriateness of each of their care decisions. Feedback will be supported with relevant reference to evidence-based guidelines, with a specific focus on the CDC opioid guidelines. Cases will cover typical primary care patients presenting with acute and chronic pain, who may or may not be already taking opioid medication.

Also known as: Clinical Performance and Value Vignettes, CPVs

Study Participants

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Board-certified in internal medicine or family medicine
• Minimum patient panel size of 1,000 patients
• At least 5% of their patients currently or previously using opioid medications
• English-speaking
• Access to the internet
• Informed, signed and voluntarily consented to be in the study

You may not qualify if:

• Not board certified in either internal medicine or family medicine
• Patient panel size less than 1,000 patients
• Less than 5% of their patients currently or previously using opioid medications
• Non-English speaking
• Unable to access the internet
• Do not voluntarily consent to be in the study

Sponsors & Collaborators

• Qure Healthcare, LLC: lead
• Ascend Learning: collaborator

Study Sites (1)

QURE Healthcare

San Francisco, California, 94109, United States

Location

Related Publications (5)

• Burgon TB, Cox-Chapman J, Czarnecki C, Kropp R, Guerriere R, Paculdo D, Peabody JW. Engaging Primary Care Providers to Reduce Unwanted Clinical Variation and Support ACO Cost and Quality Goals: A Unique Provider-Payer Collaboration. Popul Health Manag. 2019 Aug;22(4):321-329. doi: 10.1089/pop.2018.0111. Epub 2018 Oct 17.

  PMID: 30328782 BACKGROUND

• Weigel PA, Ullrich F, Shane DM, Mueller KJ. Variation in Primary Care Service Patterns by Rural-Urban Location. J Rural Health. 2016 Spring;32(2):196-203. doi: 10.1111/jrh.12146. Epub 2015 Sep 16.

  PMID: 26376210 BACKGROUND

• Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000 Apr 5;283(13):1715-22. doi: 10.1001/jama.283.13.1715.

  PMID: 10755498 BACKGROUND

• Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, Lee M. Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004 Nov 16;141(10):771-80. doi: 10.7326/0003-4819-141-10-200411160-00008.

  PMID: 15545677 BACKGROUND

• Schieber LZ, Guy GP Jr, Seth P, Young R, Mattson CL, Mikosz CA, Schieber RA. Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017. JAMA Netw Open. 2019 Mar 1;2(3):e190665. doi: 10.1001/jamanetworkopen.2019.0665.

  PMID: 30874783 BACKGROUND

MeSH Terms

Conditions

Pain; Acute Pain; Chronic Pain; Neuralgia; Opioid-Related Disorders; Behavior, Addictive

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Narcotic-Related Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders; Compulsive Behavior; Impulsive Behavior; Behavior

Study Officials

• John Peabody, MD, PhD

  QURE Healthcare

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Model Details: The study will enroll practicing PCPs in the US. All eligible and consented participants will complete a multiple-choice pre-assessment, the complete 6 weekly patient simulations with feedback and peer benchmarking, then complete a multiple-choice post-assessment.

Study Record Dates

• First Submitted: September 3, 2019
• First Posted: September 6, 2019
• Study Start: September 3, 2019
• Primary Completion: October 29, 2019
• Study Completion: October 29, 2019
• Last Updated: February 10, 2020

Record last verified: 2020-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)