The Effect of Peer Comparison Emails on Oncologists' Documentation of Cancer Stage

Study Overview
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Brief Summary
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Documenting cancer stage is the most important determinant of treatment approach and survival for cancer patients. However, oncologists do not routinely document a patient's cancer stage in the structured field in electronic health records. This quality improvement pilot study evaluated the impact of sending an email to physicians at a cancer center of a large academic hospital with individualized data on their rates of cancer stage documentation using a structured field. The investigators assessed patient-level documentation and physician-level rates of staging documentation over 15 months including a three-month pre-period, a six-month pilot phase and a six-month follow-up period. The investigators also estimated staging documentation rates separately for each physician's new versus established patients.

Official Title
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The Effect of Peer Comparison Emails on Oncologists' Documentation of Cancer Stage

Conditions
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Oncology

Intervention / Treatment
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* Other: No peer comparison email
* Other: Peer comparison email


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Attending physicians who had been at one of three sites of hospital between January - August 2018 Exclusion Criteria: Physicians treating cancer patients where American Joint Committee on Cancer (AJCC) staging modules were less clinically relevant Physicians with low clinical volume (<5 patients over 3 months) Physicians without any outpatient visits
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Comparison Group<br>Physicians in the control group did not receive peer comparison emails. | Other: No peer comparison email<br>* The comparison group received no email communication on their cancer stage documentation activity.<br>|
| Experimental: Intervention Group<br>Physicians in the intervention group received peer comparison emails. | Other: Peer comparison email<br>* The intervention group received three separate emails with individualized data on their cancer stage documentation activity in the previous 1-3 months. The email described the number and percent of attributed patients for whom cancer stage was documented, and included a figure showing their staging documentation rate compared to their peers.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measuring if a patient's cancer stage was documented in a structured field in the Electronic Health Record on the date of the patient's first ambulatory care visit | Indicator of whether the structured field for cancer stage in the patient's electronic health record (EHR) was populated on the date of the first outpatient encounter that a patient had during the study period (1=yes, 0=no) | 15 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Staging documentation rate (monthly) | Percentage of patients whose first outpatient encounter occurred in a given month for whom cancer stage was documented | 15 months |