Clinical trial NCT04176146: Nudging Healthcare Organizations to Adopt New Care Delivery Practices
Official title: Accelerating the Use of Evidence-based Innovation in Health Care Systems
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Delivery of Health Care
Lead sponsor: Dartmouth-Hitchcock Medical Center
Sponsor class: OTHER
Collaborators: name: Agency for Healthcare Research and Quality (AHRQ)
First posted: 2019-11-25
Enrollment: 2387
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This two-arm, parallel group randomized controlled trial will assess the impact of written social norms messaging (i.e., behavioral 'nudges') on healthcare organization administrators' decision to access online resources that support the adoption of evidence-based healthcare delivery practices. The healthcare delivery practices include the use of population screening tools, clinical practice guidelines, and shared decision making training.

Detailed description: The purpose of this study is to assess if behavioral 'nudges' impact the likelihood of healthcare organization administrators accessing technical assistance resources to support uptake of care delivery practices that: (1) have the potential to improve patient outcomes; and (2) have already been adopted by most healthcare organizations. A 'nudge' is a change in the way information is presented that attempts to steer people in a certain direction but does not restrict their choices.

The investigator will conduct a randomized controlled trial of written messages to healthcare administrators at three types of healthcare organizations - physician practices, hospitals and healthcare systems - from among 3,402 administrators who completed Dartmouth's National Survey of Healthcare Organizations and Systems (NSHOS) in 2017-2018.

In Fall 2019 the investigator will mail a customized report to all NSHOS respondents that compares their organizations' survey responses to their peer organizations. The investigator will randomize the 2,387 respondents whose organizations have not implemented one or more of up to seven chosen care delivery practices to cover letters with or without social norms messaging. The written messaging in the 'control condition' cover letter lists the practices for which the NSHOS team has prepared technical assistance materials in support of practice adoption, and contains a link to these online resources. The 'intervention condition' additionally highlights the organization's performance compared to its peers in adopting the practices using visual data display and explicit social norms messaging.

Eligibility criteria: Inclusion Criteria:

* Participant responded to NSHOS survey and reported that their organization had not implemented at least one of up to seven pre-determined care delivery practices, out of the following eight practices featured in the NSHOS: Screening for opioid use specifically; Screening for substance use disorders; Screening for depression; Screening for interpersonal violence; Method for identifying high-cost patients; Use of evidence-based guidelines for congestive heart failure; Use of evidence-based guidelines for sepsis (included in letters to healthcare system administrators, but not hospitals or physician practices); Training for shared decision making (included in letters to hospitals and physician practices but not healthcare systems)

Exclusion Criteria:

* Did not respond to NSHOS survey
* Participant responded to NSHOS survey and reported that their organization had already implemented each of seven pre-determined care delivery practices, out of the following eight practices featured in the NSHOS: Screening for opioid use specifically; Screening for substance use disorders; Screening for depression; Screening for interpersonal violence; Method for identifying high-cost patients; Use of evidence-based guidelines for congestive heart failure; Use of evidence-based guidelines for sepsis (included in letters to healthcare system administrators, but not hospitals or physician practices); Training for shared decision making (included in letters to hospitals and physician practices but not healthcare systems)

Primary outcomes:
measure: Percentage of participants who access the technical assistance resource webpage
timeFrame: Up to 2 months after letter is sent
Secondary outcomes:
measure: Number of unique resource views on technical assistance resource webpage
timeFrame: Up to 2 months after letter is sent
measure: Percentage of participants who request connection to peer organizations via the technical assistance resource webpage
timeFrame: Up to 2 months after letter is sent
measure: Perceived effect of letter on administrators' intentions
timeFrame: Up to 4 months after letter is sent
Other outcomes:
Locations:
city: Lebanon
country: United States
facility: Dartmouth Hitchcock Medical Center
state: New Hampshire
Study officials:
affiliation: Dartmouth College
name: Amber E Barnato, MD, MPH, MS
role: PRINCIPAL_INVESTIGATOR
References: