Clinical trial NCT02330289: Effect of Norms on Laboratory and Imaging Testing (ENLITen)
Official title: The Effect of Norms on Laboratory and Imaging Testing (ENLITen): a Pragmatic Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Utilization
Laboratory, Hospital
Lead sponsor: University of Pennsylvania
Sponsor class: OTHER
First posted: 2015-01-01
Enrollment: 154
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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.

Primary outcomes:
measure: Routine laboratory tests/patient-day
timeFrame: 6 months
Secondary outcomes:
measure: Laboratory costs
timeFrame: 6 months
measure: Routine imaging tests/patient-day
timeFrame: 6 months
measure: Physicians' attitudes toward laboratory test use and receiving feedback
timeFrame: 6 months
Other outcomes:
measure: Non-routine laboratory tests/patient-day
timeFrame: 6 months
Locations:
Study officials:
affiliation: University of Pennsylvania
name: Kira L Ryskina, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ryskina K, Jessica Dine C, Gitelman Y, Leri D, Patel M, Kurtzman G, Lin LY, Epstein AJ. Effect of Social Comparison Feedback on Laboratory Test Ordering for Hospitalized Patients: A Randomized Controlled Trial. J Gen Intern Med. 2018 Oct;33(10):1639-1645. doi: 10.1007/s11606-018-4482-y. Epub 2018 May 22.
citation: Kurtzman G, Dine J, Epstein A, Gitelman Y, Leri D, Patel MS, Ryskina K. Internal Medicine Resident Engagement with a Laboratory Utilization Dashboard: Mixed Methods Study. J Hosp Med. 2017 Sep;12(9):743-746. doi: 10.12788/jhm.2811.