Application of Behavioral Economics to Improve eConsult

Study Overview
=================
Brief Summary
-----------------
Using behavioral economics, the study objective is to increase the efficiency, quality, and timeliness of care for Los Angeles County (LAC) Department of Health Services (DHS) patients by nudging specialists toward more effective use of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care.

Detailed Description
-----------------
Historically, the Los Angeles County (LAC) Department of Health Services (DHS) Safety Net system has faced challenges in delivering specialty services that are timely, geographically equitable, and coordinated in a patient centered manner. Recently, LACDHS improved infrastructure through implementation of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care. The study investigators will conduct a pragmatic randomized trial with the goal of increasing the efficiency, quality, and timeliness of care for LACDHS patients by nudging specialists toward more effective use of eConsult. If successful, these nudges may reduce the number and increase the value of face-to-face consults.

Official Title
-----------------
Application of Behavioral Economics to Improve the Quality and Value of eConsult Specialty Reviews

Conditions
-----------------
Quality of Health Care

Intervention / Treatment
-----------------
* Behavioral: Rating tool
* Behavioral: Feedback


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: LACDHS providers who are eConsult system users Exclusion Criteria: None

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rating tool only<br>Rating eConsults from peer specialists in first phase | Behavioral: Rating tool<br>* eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)<br>|
| Experimental: Feedback only<br>Receiving feedback from peer specialists in first phase | Behavioral: Feedback<br>* eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)<br>|
| Experimental: Rating Tool plus Feedback<br>Both rating and feedback in second phase. | Behavioral: Rating tool<br>* eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)<br>Behavioral: Feedback<br>* eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rating - Medical Decision Making | Peers' ratings of Medical Decision Making in Specialists' responses to PCPs | Baseline to Post-Intervention, up to 12 months | 
| Rating - Application of Expected Practices | Peers' ratings of Expected Practices in Specialists' responses to PCPs | Baseline to Post-Intervention, up to 12 months | 
| Rating - Relationship Building | Peers' ratings Relationship Building in Specialists' responses to PCPs | Baseline to Post-Intervention, up to 12 months | 
| Rating - Expert Elicitation | Peers' ratings of Specialists' skill in elicitation of information from PCPs | Baseline to Post-Intervention, up to 12 months | 
| Rating - Educational Value | Peers' ratings of Educational Value of eConsults | Baseline to Post-Intervention, up to 12 months |