Effect of Norms on Laboratory and Imaging Testing (ENLITen)

Study Overview
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Brief Summary
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Studies suggest that some laboratory tests ordered for hospitalized patients are duplicative or have limited value. This study will evaluate a normative feedback intervention to reduce overuse of laboratory tests for hospitalized patients by internal medicine physicians-in-training.

Detailed Description
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Past research has shown that 25% of diagnostic testing is duplicative or has limited value. Academic medical centers that employ physicians-in-training may find it particularly challenging to reduce low value testing due to a historical emphasis on extensive workups by trainees. Despite the increased emphasis on cost-consciousness in medical education, there is little existing research evaluating ways to optimize ordering behaviors of physicians-in-training. This study will evaluate a normative feedback intervention for internal medicine physicians-in-training to reduce overuse of routine laboratory tests for hospitalized patients. Physicians-in-training will be cluster-randomized into two arms: (1) those who receive report cards (intervention group), (2) those who will not receive report cards (control group). We will study the use of routine laboratory tests over a pre-intervention period of 1 week and a post-randomization period of 1 week. We will study physician attitudes about the real-time feedback dashboard with qualitative assessments in focus groups after the completion of the intervention.

Official Title
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The Effect of Norms on Laboratory and Imaging Testing (ENLITen): a Pragmatic Randomized Controlled Trial

Conditions
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Utilization, Laboratory, Hospital

Intervention / Treatment
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* Behavioral: Normative report card


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any internal medicine physician-in-training scheduled to rotate through general medicine services at HUP during the study period will be included in the study. Exclusion Criteria: Physicians-in-training pulled for weekend coverage or sick coverage will be excluded. Medical students will be excluded.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

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 |
| --- | --- |
| Experimental: Report card arm<br>The intervention arm will receive an email report card describing their lab use compared to their peers as well as a link to a website visually tracking the team's daily ordering of common lab tests compared to the peer teams. | Behavioral: Normative report card<br>* Personalized visual report card describing physician's laboratory ordering pattern for prior week relative to peers as well as a link to a website tracking lab ordering for the team in real time compared to peer teams.<br>|
| No Intervention: Control arm<br>Physicians in the control arm will not receive the email or website link. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Routine laboratory tests/patient-day | the number of routine laboratory tests per patient-day ordered by the physicians-in-training | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Laboratory costs |  | 6 months | 
| Routine imaging tests/patient-day |  | 6 months | 
| Physicians' attitudes toward laboratory test use and receiving feedback | Focus groups | 6 months |