Choosing Tests Wisely in Rheumatology

Study Overview
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Brief Summary
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This is a randomized study intended to produce a reduction in ordering of inappropriate tests by general practitioners as determined by recommendations from the CRA's Choosing Wisely guidelines. This reduction of inappropriate testing is expected in referrals to the rheumatologists randomized to the intervention group. This study will further explore which recommendations from the Canadian Rheumatology Association (CRA)/Canada Choosing Wisely campaign have the most impact on regional referring physicians to the Rheumatology clinic at St. Joseph's Hospital, London.

Detailed Description
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This a randomized study in that 6 rheumatologists (30 referrals each) will be randomized to one of two groups: intervention or control. Referring physicians to the intervention group will be faxed a brief Choosing Wisely form (intervention) based upon the recommendations of the Canadian Rheumatology Association's (CRA) Canada Choosing Wisely campaign, while referring physicians from the control group will not receive the form (non intervention). Analysis will be based upon the results of a three question survey faxed to all referring physicians at year one and at year two and on future referrals from the referring physicians to determine if there is a reduction in the group of ordering physicians that received the intervention (Choosing Wisely form).

Official Title
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Choosing Tests Wisely in Rheumatology

Conditions
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SLE

Intervention / Treatment
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* Other: Choosing Wisely form


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ordering physicians who recently made a referral to the Rheumatology clinic at St. Joseph's Health Care. Exclusion Criteria: N/A, all recent referrals will be included.

Ages Eligible for Study
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Minimum Age: 18 Years

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
Interventional Model Description: Randomized Study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Group<br>Ordering physicians who have referred to a rheumatologist in the St. Joseph's rheumatology clinic randomized to the intervention group will receive a brief Choosing Wisely form (for education of guidelines) faxed with the referral notice. At one and two years all ordering physicians will receive by fax a three question survey. | Other: Choosing Wisely form<br>* The investigators will fax a Choosing Wisely form to ordering physicians that will include information from the Canadian Rheumatology Association Canada Choosing Wisely Guidelines. Three points will be included with some additional explanation of why these are important. The three guidelines included will be: Don't order an ANA as a screening test in patients without specific signs or symptoms of systemic lupus erythematous (SLE) or another connective tissue disorder (CTD). Don't routinely image patients with low back pain regardless of the duration of symptoms unless that are clinical reasons to suspect serious underlying pathology Don' routinely order a shoulder ultrasound as it is likely to indicate a tear in many people over the age of 50 years and will not change the initial management.<br>|
| No Intervention: Control Group<br>Ordering physicians who have referred to rheumatologists in the control group will not receive the Choosing Wisely form. At one and two years all ordering physicians will receive by fax a three question survey. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessing the change in the number of the total number of ANA tests, back CT's and shoulder ultrasounds in rheumatology referrals | -collecting the total number of ANA tests, back CT's and shoulder ultrasounds | Change from baseline number of tests at year one, year two | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rheumatology Referral, Choosing Wisely