Clinical trial NCT03784950: Application of Behavioral Economics to Improve eConsult
Official title: Application of Behavioral Economics to Improve the Quality and Value of eConsult Specialty Reviews
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Quality of Health Care
Lead sponsor: University of Southern California
Sponsor class: OTHER
Collaborators: name: Los Angeles County Department of Public Health
First posted: 2018-12-24
Enrollment: 220
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

Eligibility criteria: Inclusion Criteria:

* LACDHS providers who are eConsult system users

Exclusion Criteria:

* None

Primary outcomes:
measure: Rating - Medical Decision Making
timeFrame: Baseline to Post-Intervention, up to 12 months
measure: Rating - Application of Expected Practices
timeFrame: Baseline to Post-Intervention, up to 12 months
measure: Rating - Relationship Building
timeFrame: Baseline to Post-Intervention, up to 12 months
measure: Rating - Expert Elicitation
timeFrame: Baseline to Post-Intervention, up to 12 months
measure: Rating - Educational Value
timeFrame: Baseline to Post-Intervention, up to 12 months
Secondary outcomes:
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: Los Angeles County Department of Health Services
state: California
Study officials:
affiliation: University of Southern California
name: Daniella Meeker, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Barnett ML, Yee HF Jr, Mehrotra A, Giboney P. Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists. Health Aff (Millwood). 2017 Mar 1;36(3):492-499. doi: 10.1377/hlthaff.2016.1283.
citation: Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis. JAMA Intern Med. 2018 Jun 1;178(6):782-789. doi: 10.1001/jamainternmed.2018.0738.
citation: Behavioral Economics and eConsult Steering Committee; Meeker D, Friedberg MW, Knight TK, Doctor JN, Zein D, Cayasso-McIntosh N, Goldstein NJ, Fox CR, Linder JA, Persell SD, Dea S, Giboney P, Yee HF. Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial. J Gen Intern Med. 2022 May;37(6):1400-1407. doi: 10.1007/s11606-021-07002-1. Epub 2021 Sep 9.