Improving Quality & Equity of Emergency Care Decisions (IQED)

• Sponsor: University of Southern California (Other)
• Overall Status: Withdrawn
• CT.gov ID: NCT03966989
• Collaborator: National Institute on Aging (NIA) (NIH), University of California, Los Angeles (Other), Olive View-UCLA Education & Research Institute (Other), LAC+USC Medical Center (Other), University of California, Davis (Other)
• Enrollment: 0
• Locations: 4
• Arms: 2
• Anticipated Duration (Months): 6
• Patients Per Site: 0
• Patients Per Site Per Month: 0

Study Details

Study Description

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.

Condition or Disease	Intervention/Treatment	Phase
Emergency Department	Behavioral: Performance Feedback	N/A

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.

Study Design

• Study Type: Interventional
• Actual Enrollment: 0 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Improving Quality & Equity of Emergency Care Decisions (IQED): R21 Pilot Phase
• Anticipated Study Start Date: Dec 1, 2021
• Anticipated Primary Completion Date: Jun 1, 2022
• Anticipated Study Completion Date: Jun 1, 2022

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Performance Feedback Feedback offline either via email or text	Behavioral: Performance Feedback; Performance feedback offline that benchmarks providers' own performance to that of their peers
No Intervention: Control Standard practice control

Outcome Measures

Primary Outcome Measures

1. Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Chest Pain [6 months]

   Measurement of clinician adherence to guidelines for quality measures related to chest pain (proportion of cases in which HEART score algorithm was used for chest pain patients)

2. Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: CT imaging [6 months]

   Measurement of clinician adherence to guidelines for quality measures related to CT imaging (proportion of orders for unnecessary CT scans)

3. Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Antibiotic prescribing [6 months]

   Measurement of clinician adherence to guidelines for quality measures related to antibiotic prescribing (proportion of inappropriate antibiotic prescriptions for acute respiratory infections)

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

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

Exclusion Criteria:

• None

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Lac + Usc	Los Angeles	California	United States	90033
2	University of California, Davis	Sacramento	California	United States	95817
3	Olive View Medical Center	Sylmar	California	United States	91342
4	Harbor UCLA	Torrance	California	United States	90502

Sponsors and Collaborators

• University of Southern California
• National Institute on Aging (NIA)
• University of California, Los Angeles
• Olive View-UCLA Education & Research Institute
• LAC+USC Medical Center
• University of California, Davis

Investigators

• Principal Investigator: Daniella Meeker, University of Southern California

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Daniella Meeker, Assistant Professor, University of Southern California
• ClinicalTrials.gov Identifier: NCT03966989
• Other Study ID Numbers: HS-18-00522; R21AG057400
• First Posted: May 29, 2019
• Last Update Posted: Dec 20, 2021
• Last Verified: Dec 1, 2021

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Daniella Meeker, Assistant Professor, University of Southern California: Emergency Medicine; Behavioral Research
• Additional relevant MeSH terms: Emergencies

Study Results

No Results Posted as of Dec 20, 2021