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Improving Quality & Equity of Emergency Care Decisions (IQED) (IQED)

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ClinicalTrials.gov Identifier: NCT03966989
Recruitment Status : Suspended (Suspended due to COVID-19 pandemic)
First Posted : May 29, 2019
Last Update Posted : December 23, 2020
Sponsor:
Collaborators:
National Institute on Aging (NIA)
University of California, Los Angeles
Olive View-UCLA Education & Research Institute
LAC+USC Medical Center
University of California, Davis
Information provided by (Responsible Party):
Daniella Meeker, University of Southern California

Brief Summary:
Recent work in emergency medicine has shown errors were more likely to occur at the end of shifts, as pressure exists to make a number of decisions simultaneously, and after what may be an already long series of cognitive challenges. Decision fatigue may also contribute to disparities by surfacing subconscious bias. The objective of the R21 pilot phase of Improving Quality & Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.

Condition or disease Intervention/treatment Phase
Emergency Department Behavioral: Performance Feedback Not Applicable

Detailed Description:

The objective of the R21 pilot phase of Improving Quality & Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.

Each clinician will be randomized at the provider or clinic level to either the intervention or control group. Once clinicians are randomized, the aforementioned intervention will be turned on for a 3-6 month time period.

For providers in the intervention group, the goal is to evaluate the effect of social norms on overuse and underuse behavior related to prescriptions or testing. Near real-time social norms will be delivered to providers which benchmark their own performance on various metrics to that of their peers. The investigators performance feedback reports for each provider randomized to receive the audit and feedback intervention will have three key characteristics: (1) each target provider will receive his or her individual performance, (2) benchmarks will prominently feature the performance of providers who would be considered credible peers of the target provider, and (3) benchmarks will reflect only performance that is desirable (e.g., showing only the performance of the best-performing credible peers).

Providers randomized to the control group will follow standard practice.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 80 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Improving Quality & Equity of Emergency Care Decisions (IQED): R21 Pilot Phase
Estimated Study Start Date : June 2021
Estimated Primary Completion Date : June 2022
Estimated Study Completion Date : June 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Performance Feedback
Feedback offline either via email or text
Behavioral: Performance Feedback
Performance feedback offline that benchmarks providers' own performance to that of their peers

No Intervention: Control
Standard practice control



Primary Outcome Measures :
  1. Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Chest Pain [ Time Frame: 6 months ]
    Measurement of clinician adherence to guidelines for quality measures related to chest pain (proportion of cases in which HEART score algorithm was used for chest pain patients)

  2. Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: CT imaging [ Time Frame: 6 months ]
    Measurement of clinician adherence to guidelines for quality measures related to CT imaging (proportion of orders for unnecessary CT scans)

  3. Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Antibiotic prescribing [ Time Frame: 6 months ]
    Measurement of clinician adherence to guidelines for quality measures related to antibiotic prescribing (proportion of inappropriate antibiotic prescriptions for acute respiratory infections)



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Attendings and residents that see patients in the Emergency Department.

Exclusion Criteria:

  • None

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03966989


Locations
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United States, California
Lac + Usc
Los Angeles, California, United States, 90033
University of California, Davis
Sacramento, California, United States, 95817
Olive View Medical Center
Sylmar, California, United States, 91342
Harbor UCLA
Torrance, California, United States, 90502
Sponsors and Collaborators
University of Southern California
National Institute on Aging (NIA)
University of California, Los Angeles
Olive View-UCLA Education & Research Institute
LAC+USC Medical Center
University of California, Davis
Investigators
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Principal Investigator: Daniella Meeker University of Southern California
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Responsible Party: Daniella Meeker, Assistant Professor, University of Southern California
ClinicalTrials.gov Identifier: NCT03966989    
Other Study ID Numbers: HS-18-00522
R21AG057400 ( U.S. NIH Grant/Contract )
First Posted: May 29, 2019    Key Record Dates
Last Update Posted: December 23, 2020
Last Verified: December 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Daniella Meeker, University of Southern California:
Emergency Medicine
Behavioral Research
Additional relevant MeSH terms:
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Emergencies
Disease Attributes
Pathologic Processes