Applying the Intention-Action Framework to Specialty Referrals

NCT07671976 | Active Not Recruiting DMC

• 3 other identifiers: IRB-25-2243P30AG034532P30AG024968
• Study Type: interventional
• Target: 1,600
• Locations: 1 country
• Sites: 1

Brief Summary

This is a prospective randomized controlled trial evaluating an EHR-embedded behavioral intervention intended to reduce low-value specialty referrals in cardiology, pulmonology, and gastroenterology. The intervention is designed to (1) strengthen physicians' intentions to avoid low-value specialty referrals at the point of encounter by presenting criteria for high-value referrals and informing physicians that referral decisions may be reviewed and (2) support follow-through on these intentions by modifying the referral process through structured checklist prompts embedded within the referral workflow. The primary hypothesis is that physicians exposed to the intervention will demonstrate lower rates of low-value cardiology, pulmonology, and gastroenterology referrals compared with physicians exposed to the arm where the order composer allows physicians to place referrals with minimal decision support.

Conditions

Cardiology; Gastroenterology; Pulmonology

Keywords

Low-value referral; Behavioral science; Physician decision-making; Quality improvement; Cardiology; Pulmonology; Gastroenterology

Outcome Measures

Primary Outcomes (1)

• Physician-level rate of low-value specialty referrals per 100 referral relevant encounters

  A low-value referral is defined as a referral to one of the three target specialty divisions placed during a referral-relevant encounter that does not meet the pre-specified referral criteria developed by UCLA Health division chiefs for the corresponding medical condition. The primary outcome is calculated as the number of low-value referrals divided by the number of referral-relevant encounters, multiplied by 100, aggregated at the physician level.

  During 6-month intervention period

Secondary Outcomes (5)

• Rate of total specialty referrals in the target divisions per 100 referral-relevant encounters

  During 6-month intervention period

• Rate of high-value specialty referrals in the target divisions per 100 referral-relevant encounters

  During 6-month intervention period

• Rate of unplanned hospital admissions (within 30 days) per 100 referral-relevant encounters

  During 6-month intervention period

• Rate of emergency department visits (within 30 days) per 100 referral-relevant encounters

  During 6-month intervention period

• Rate of all-cause mortality (within 30 days) per 100 referral-relevant encounters

  During 6-month intervention period

Study Arms (3)

Arm 1: Control

NO INTERVENTION

Eligible, randomly assigned physicians use a basic order composer, which allows them to place referrals with minimal support.

Arm 2: Information + Review

EXPERIMENTAL

Eligible, randomly assigned physicians use an order composer that displays criteria for high-value referrals and informs them that their referral decisions may be reviewed.

Behavioral: Information provision; Behavioral: Auditing

Arm 3: Information + Review + Checklist

EXPERIMENTAL

Eligible, randomly assigned physicians use an order composer that displays high-value referral criteria, informs them that their referral decisions may be reviewed, and includes cascading checkboxes prompting them to confirm that referral criteria are met before submitting.

Behavioral: Information provision; Behavioral: Auditing; Behavioral: Checklist

Interventions

Information provision BEHAVIORAL

The order composer displays high-value criteria developed by UCLA Health using professional society guidelines and expert consensus from clinical leadership.

Arm 2: Information + Review; Arm 3: Information + Review + Checklist

Auditing BEHAVIORAL

The order composer notifies physicians that their referral decisions may be subject to review.

Arm 2: Information + Review; Arm 3: Information + Review + Checklist

Checklist BEHAVIORAL

The order composer includes cascading checkboxes that prompt physicians to confirm that referral criteria are met before submitting a referral. Physicians must actively indicate whether the patient meets referral criteria before submitting a referral. Physicians who determine that a referral remains clinically appropriate despite the patient not meeting listed criteria may select an option indicating that none of the listed criteria apply and provide a brief free-text explanation for proceeding with the referral.

Arm 3: Information + Review + Checklist

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• UCLA Health physicians who have made at least one specialty referral to cardiology, pulmonology, or gastroenterology for patients in UCLA Health primary care registry during July-December 2025

You may not qualify if:

• Physicians who are no longer actively practicing at UCLA Health as of July 1, 2026

Sponsors & Collaborators

• University of California, Los Angeles: lead
• National Institute on Aging (NIA): collaborator

Study Sites (1)

UCLA Health Department of Medicine

Los Angeles, California, 90095, United States

Location

MeSH Terms

Interventions

Checklist

Intervention Hierarchy (Ancestors)

Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: Parallel randomized trial at the physician level

Study Record Dates

• First Submitted: June 22, 2026
• First Posted: June 26, 2026
• Study Start: July 1, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): January 31, 2027
• Last Updated: July 22, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)