Application of Behavioral Economics to Improve eConsult

NCT ID: NCT03784950

Last Updated: 2018-12-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-03-01

Study Completion Date

2018-08-31

Brief Summary

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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

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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.

Conditions

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Quality of Health Care

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Rating tool only

Rating eConsults from peer specialists in first phase

Group Type EXPERIMENTAL

Rating tool

Intervention Type BEHAVIORAL

eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)

Feedback only

Receiving feedback from peer specialists in first phase

Group Type EXPERIMENTAL

Feedback

Intervention Type BEHAVIORAL

eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)

Rating Tool plus Feedback

Both rating and feedback in second phase.

Group Type EXPERIMENTAL

Rating tool

Intervention Type BEHAVIORAL

eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)

Feedback

Intervention Type BEHAVIORAL

eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)

Interventions

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Rating tool

eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)

Intervention Type BEHAVIORAL

Feedback

eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* LACDHS providers who are eConsult system users

Exclusion Criteria

* None
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Los Angeles County Department of Public Health

OTHER_GOV

Sponsor Role collaborator

University of Southern California

OTHER

Sponsor Role lead

Responsible Party

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Daniella Meeker

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Daniella Meeker, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Southern California

Locations

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Los Angeles County Department of Health Services

Los Angeles, California, United States

Site Status

Countries

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United States

References

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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.

Reference Type BACKGROUND
PMID: 28264951 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 29801079 (View on PubMed)

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.

Reference Type DERIVED
PMID: 34505234 (View on PubMed)

Other Identifiers

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HS-17-00077

Identifier Type: -

Identifier Source: org_study_id