Clinical trial NCT03966989: Improving Quality & Equity of Emergency Care Decisions (IQED)
Official title: Improving Quality & Equity of Emergency Care Decisions (IQED): R21 Pilot Phase
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: NA
Conditions: Emergency Department
Keywords: Emergency Medicine
Behavioral Research
Lead sponsor: University of Southern California
Sponsor class: OTHER
Collaborators: name: National Institute on Aging (NIA)
name: University of California, Los Angeles
name: Olive View-UCLA Education & Research Institute
name: LAC+USC Medical Center
name: University of California, Davis
First posted: 2019-05-29
Enrollment: 0
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Recent work in emergency medicine has shown errors were more likely to occur at the end of shifts, as pressure exists to make a number of decisions simultaneously, and after what may be an already long series of cognitive challenges. Decision fatigue may also contribute to disparities by surfacing subconscious bias. The objective of the R21 pilot phase of Improving Quality \& Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.

Detailed description: The objective of the R21 pilot phase of Improving Quality \& Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.

Each clinician will be randomized at the provider or clinic level to either the intervention or control group. Once clinicians are randomized, the aforementioned intervention will be turned on for a 3-6 month time period.

For providers in the intervention group, the goal is to evaluate the effect of social norms on overuse and underuse behavior related to prescriptions or testing. Near real-time social norms will be delivered to providers which benchmark their own performance on various metrics to that of their peers. The investigators performance feedback reports for each provider randomized to receive the audit and feedback intervention will have three key characteristics: (1) each target provider will receive his or her individual performance, (2) benchmarks will prominently feature the performance of providers who would be considered credible peers of the target provider, and (3) benchmarks will reflect only performance that is desirable (e.g., showing only the performance of the best-performing credible peers).

Providers randomized to the control group will follow standard practice.

Eligibility criteria: Inclusion Criteria:

* Attendings and residents that see patients in the Emergency Department.

Exclusion Criteria:

* None

Primary outcomes:
measure: Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Chest Pain
timeFrame: 6 months
measure: Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: CT imaging
timeFrame: 6 months
measure: Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Antibiotic prescribing
timeFrame: 6 months
Secondary outcomes:
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: Lac + Usc
state: California
city: Sacramento
country: United States
facility: University of California, Davis
state: California
city: Sylmar
country: United States
facility: Olive View Medical Center
state: California
city: Torrance
country: United States
facility: Harbor UCLA
state: California
Study officials:
affiliation: University of Southern California
name: Daniella Meeker
role: PRINCIPAL_INVESTIGATOR
References: