Trial Outcomes & Findings for Using Behavioral Economics to Reduce Low-Value Care (NCT NCT04104256)
NCT ID: NCT04104256
Last Updated: 2024-09-19
Results Overview
Change in percentage of patients undergoing pre-operative testing (labs, EKG, CXR)
Recruitment status
COMPLETED
Study phase
NA
Target enrollment
1045 participants
Primary outcome timeframe
Pre-intervention (Baseline), Post-Intervention (12 months)
Results posted on
2024-09-19
Participant Flow
Participants were enrolled into the study when they have a pre-operative encounter for cataract surgery AND the physician starts to order a pre-op lab. Eligible providers were assigned an arm of the study based on their 2019 pre-operative visits. Patients were enrolled into each arm based on the providers arm assignment. Healthcare Providers were not enrolled in the study
Participant milestones
| Measure |
Alert 1
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #1 group.
Nudge #1: Alert highlighting the safety/potential harms to patients of undergoing pre-op tests: Nudge 1:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-op tests do NOT increase patient safety and go AGAINST local and national guidelines Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 2
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #2 group.
Nudge #2: Alert highlighting the financial harms to the patient experiencing pre-op tests: Nudge #2:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can increase the patient's out-of-pocket costs without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Nudge includes "hard stop" before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 3
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #3 group.
Nudge #3: Alert highlighting potential psychological harms to the patient of experiencing pre-op tests: Nudge 3:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can cause aggravation and psychological stress for the patient without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Control
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Control group. Encounter continues as usual.
Usual Care: Patients will receive usual care from their physicians.
|
|---|---|---|---|---|
|
Overall Study
STARTED
|
269
|
267
|
272
|
237
|
|
Overall Study
COMPLETED
|
269
|
267
|
272
|
237
|
|
Overall Study
NOT COMPLETED
|
0
|
0
|
0
|
0
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
Using Behavioral Economics to Reduce Low-Value Care
Baseline characteristics by cohort
| Measure |
Alert 1
n=269 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #1 group.
Nudge #1: Alert highlighting the safety/potential harms to patients of undergoing pre-op tests: Nudge 1:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-op tests do NOT increase patient safety and go AGAINST local and national guidelines Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 2
n=267 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #2 group
Nudge #2: Alert highlighting the financial harms to the patient experiencing pre-op tests: Nudge #2:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can increase the patient's out-of-pocket costs without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Nudge includes "hard stop" before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 3
n=272 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #3 group
Nudge #3: Alert highlighting potential psychological harms to the patient of experiencing pre-op tests: Nudge 3:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can cause aggravation and psychological stress for the patient without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Control
n=237 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Control group.
Usual Care: Patients will receive usual care from their physicians.
|
Total
n=1045 Participants
Total of all reporting groups
|
|---|---|---|---|---|---|
|
Age, Continuous
|
71.07 years
STANDARD_DEVIATION 9.58 • n=5 Participants
|
72.00 years
STANDARD_DEVIATION 10.98 • n=7 Participants
|
72.98 years
STANDARD_DEVIATION 9.61 • n=5 Participants
|
72.27 years
STANDARD_DEVIATION 10.24 • n=4 Participants
|
72.08 years
STANDARD_DEVIATION 9.37 • n=21 Participants
|
|
Sex: Female, Male
Female
|
168 Participants
n=5 Participants
|
140 Participants
n=7 Participants
|
161 Participants
n=5 Participants
|
126 Participants
n=4 Participants
|
595 Participants
n=21 Participants
|
|
Sex: Female, Male
Male
|
101 Participants
n=5 Participants
|
127 Participants
n=7 Participants
|
111 Participants
n=5 Participants
|
111 Participants
n=4 Participants
|
450 Participants
n=21 Participants
|
|
Ethnicity (NIH/OMB)
Hispanic or Latino
|
28 Participants
n=5 Participants
|
34 Participants
n=7 Participants
|
38 Participants
n=5 Participants
|
26 Participants
n=4 Participants
|
126 Participants
n=21 Participants
|
|
Ethnicity (NIH/OMB)
Not Hispanic or Latino
|
214 Participants
n=5 Participants
|
203 Participants
n=7 Participants
|
204 Participants
n=5 Participants
|
178 Participants
n=4 Participants
|
799 Participants
n=21 Participants
|
|
Ethnicity (NIH/OMB)
Unknown or Not Reported
|
27 Participants
n=5 Participants
|
30 Participants
n=7 Participants
|
30 Participants
n=5 Participants
|
33 Participants
n=4 Participants
|
120 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · Black or African American
|
20 Participants
n=5 Participants
|
11 Participants
n=7 Participants
|
18 Participants
n=5 Participants
|
18 Participants
n=4 Participants
|
67 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · White
|
142 Participants
n=5 Participants
|
132 Participants
n=7 Participants
|
148 Participants
n=5 Participants
|
131 Participants
n=4 Participants
|
553 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · Unknown or Not Reported
|
36 Participants
n=5 Participants
|
40 Participants
n=7 Participants
|
29 Participants
n=5 Participants
|
30 Participants
n=4 Participants
|
135 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · Asian
|
33 Participants
n=5 Participants
|
45 Participants
n=7 Participants
|
31 Participants
n=5 Participants
|
24 Participants
n=4 Participants
|
133 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · Hispanic or Latino
|
26 Participants
n=5 Participants
|
32 Participants
n=7 Participants
|
37 Participants
n=5 Participants
|
26 Participants
n=4 Participants
|
121 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · Middle Eastern or North African
|
7 Participants
n=5 Participants
|
4 Participants
n=7 Participants
|
5 Participants
n=5 Participants
|
5 Participants
n=4 Participants
|
21 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · Multiple Ethnoracial Categories
|
5 Participants
n=5 Participants
|
3 Participants
n=7 Participants
|
3 Participants
n=5 Participants
|
2 Participants
n=4 Participants
|
13 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
EthnoRacial Category · Native Hawaiian or Other Pacific Islander
|
0 Participants
n=5 Participants
|
0 Participants
n=7 Participants
|
1 Participants
n=5 Participants
|
1 Participants
n=4 Participants
|
2 Participants
n=21 Participants
|
PRIMARY outcome
Timeframe: Pre-intervention (Baseline), Post-Intervention (12 months)Population: The participants in this study are UCLA Health physicians who complete a pre-op visit for at least one patient undergoing cataract surgery at UCLA in the 12 months prior and 12 months after the study start date and all patients who are seen during such visits.
Change in percentage of patients undergoing pre-operative testing (labs, EKG, CXR)
Outcome measures
| Measure |
Alert 1
n=75 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #1 group.
Nudge #1: Alert highlighting the safety/potential harms to patients of undergoing pre-op tests: Nudge 1:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-op tests do NOT increase patient safety and go AGAINST local and national guidelines Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 2
n=66 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #2 group.
Nudge #2: Alert highlighting the financial harms to the patient experiencing pre-op tests: Nudge #2:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can increase the patient's out-of-pocket costs without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Nudge includes "hard stop" before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 3
n=69 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #3 group.
Nudge #3: Alert highlighting potential psychological harms to the patient of experiencing pre-op tests: Nudge 3:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can cause aggravation and psychological stress for the patient without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Control
n=76 Participants
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Control group
Usual Care: Patients will receive usual care from their physicians.
|
|---|---|---|---|---|
|
Pre-Operative Testing Change
Pre
|
87.4 Percentage of patients with orders
Standard Deviation 33.2
|
85.0 Percentage of patients with orders
Standard Deviation 35.8
|
86.1 Percentage of patients with orders
Standard Deviation 34.6
|
85.4 Percentage of patients with orders
Standard Deviation 35.4
|
|
Pre-Operative Testing Change
Post
|
84.6 Percentage of patients with orders
Standard Deviation 36.2
|
80.3 Percentage of patients with orders
Standard Deviation 39.9
|
79.8 Percentage of patients with orders
Standard Deviation 40.3
|
83.5 Percentage of patients with orders
Standard Deviation 37.2
|
SECONDARY outcome
Timeframe: Pre-intervention (Baseline), Post-Intervention (12 months)Efficacy of each individual nudge arm compared with usual care to determine whether certain behavioral economic framing techniques are more effective than others at reducing pre-op testing.
Outcome measures
Outcome data not reported
SECONDARY outcome
Timeframe: Pre-intervention (Baseline), Post-Intervention (12 months)Change in the percentage of patients who received pre-op labs, pre-op EKGs, and pre-op chest x-rays (CXRs).
Outcome measures
Outcome data not reported
SECONDARY outcome
Timeframe: Post-Intervention (12 months)Perceived change in workflow, autonomy, satisfaction (Modified Survey)
Outcome measures
Outcome data not reported
SECONDARY outcome
Timeframe: Baseline, 12 monthsAnalysis of day of surgery cancellations for enrolled participants
Outcome measures
Outcome data not reported
SECONDARY outcome
Timeframe: Pre-intervention (Baseline), Post-Intervention (12 months)Analysis of costs saved for enrolled participants
Outcome measures
Outcome data not reported
SECONDARY outcome
Timeframe: Pre-intervention (Baseline), Post-Intervention (12 months)Analysis of cost savings to the health system assuming a reduction of tests being ordered
Outcome measures
Outcome data not reported
Adverse Events
Alert 1
Serious events: 11 serious events
Other events: 9 other events
Deaths: 1 deaths
Alert 2
Serious events: 4 serious events
Other events: 7 other events
Deaths: 3 deaths
Alert 3
Serious events: 4 serious events
Other events: 12 other events
Deaths: 0 deaths
Control
Serious events: 12 serious events
Other events: 12 other events
Deaths: 2 deaths
Serious adverse events
| Measure |
Alert 1
n=269 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #1 group
Nudge #1: Alert highlighting the safety/potential harms to patients of undergoing pre-op tests: Nudge 1:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-op tests do NOT increase patient safety and go AGAINST local and national guidelines Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 2
n=267 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #2 group
Nudge #2: Alert highlighting the financial harms to the patient experiencing pre-op tests: Nudge #2:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can increase the patient's out-of-pocket costs without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Nudge includes "hard stop" before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 3
n=272 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #3 group
Nudge #3: Alert highlighting potential psychological harms to the patient of experiencing pre-op tests: Nudge 3:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can cause aggravation and psychological stress for the patient without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Control
n=237 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Control group
Usual Care: Patients will receive usual care from their physicians.
|
|---|---|---|---|---|
|
General disorders
Inpatient Admission
|
4.1%
11/269 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
1.5%
4/267 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
1.5%
4/272 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
5.1%
12/237 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
Other adverse events
| Measure |
Alert 1
n=269 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #1 group
Nudge #1: Alert highlighting the safety/potential harms to patients of undergoing pre-op tests: Nudge 1:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-op tests do NOT increase patient safety and go AGAINST local and national guidelines Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 2
n=267 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #2 group
Nudge #2: Alert highlighting the financial harms to the patient experiencing pre-op tests: Nudge #2:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can increase the patient's out-of-pocket costs without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Nudge includes "hard stop" before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Alert 3
n=272 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Nudge #3 group
Nudge #3: Alert highlighting potential psychological harms to the patient of experiencing pre-op tests: Nudge 3:
* UCLA Ophthalmologists and Anesthesiologists ADVISE AGAINST routine pre-op testing.
* UCLA Pre-op Eval and Planning Center (PEPC) will order any needed labs on the day of surgery.
* Routine pre-op tests are inappropriate.
* Routine pre-operative tests can cause aggravation and psychological stress for the patient without improving the safety or medical outcomes of cataract surgery and go AGAINST local and national guidelines
* Hard stop before allowing the ordering of a pre-op test where physicians must provide accountable justification: "EXPLAIN WHY GOING AGAINST GUIDELINES"
|
Control
n=237 participants at risk
Patients with a pre-op encounter in which the physician attempts to place an order for a pre-op test. Physician has been assigned to the Control group
Usual Care: Patients will receive usual care from their physicians.
|
|---|---|---|---|---|
|
General disorders
Emergency Department visits that did not require admissions
|
3.3%
9/269 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
2.6%
7/267 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
4.4%
12/272 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
5.1%
12/237 • Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.
An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events
|
Additional Information
Project Manager
University of California Los Angeles, Division of General Internal Medicine and Health Services Research
Phone: 310-825-8253
Email: [email protected]
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place