Evaluation of the Use of Medical Scribes in VAMC Emergency Departments and Specialty Care Clinics
NCT ID: NCT04154462
Last Updated: 2022-08-30
Study Results
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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COMPLETED
NA
12 participants
INTERVENTIONAL
2019-03-01
2022-07-01
Brief Summary
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Who can participate? Urban and rural VAMCs willing to be assigned medical scribes for use in EDs or selected high wait time specialty clinics (cardiology, orthopedics).
What does the study involve? Four medical scribes will be assigned to each of the 12 VAMC sites randomized into treatment with the VA hiring half as new employees and contracting out for the remaining half. 30% of the scribes will be assigned to emergency departments and the other 70% will be assigned to specialty care. Remaining sites that expressed interest in the pilot but were not randomized treatment will be used as comparators. Provider productivity, patient volume, wait times, and patient satisfaction from the treated sites will be compared to baseline (pre-scribe) data as well as data from comparison sites.
What are the possible benefits and risks of participating? VAMCs where medical scribes are introduced may see gains in provider efficiency, reduced wait times, and increased patient satisfaction due to the shifting of administrative burdens associated with documenting patient encounters in electronic health records from providers to these trained professionals. The introduction of medical scribes could complicate patient encounters by making some patients and/or providers uncomfortable.
Where is the study run from? This study is being coordinated by the Partnered Evidence-based Policy Resource Center (PEPReC) at the VA Boston Healthcare System in collaboration with the VA Office of Veterans Access to Care (OVAC).
When is the study starting and how long is it expected to run for? March 2020 to February 2022
Who is funding the study? U.S. Veterans Health Administration
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
Each VAMC site randomized to treatment will have two VA employee scribes and two contract scribes. Two medical scribes, ideally one employee and one contract, will be assigned to one physician, with two physicians and/or Licensed Independent Practitioners (LIP) participating at each facility. Scribes will work with others if the provider partner is not available during a scheduled shift. Power analyses have been conducted to determine the minimum effect size for each outcome with 80% power, which will be useful for putting the final results into context.
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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No intervention
The VAMC sites randomized to the comparison arm will not have medical scribes introduced into emergency departments or specialty clinics.
No interventions assigned to this group
Treatment
The VAMC sites randomized to the treatment arm are each expected to have four medical scribes, with two being VA employees and two being contractors, introduced into emergency departments or specialty clinics to assist providers during patient encounters.
Scribes
Section 507 of the MISSION Act of 2018 mandates a two-year pilot of medical scribes in VA specialty clinics and emergency departments. Medical scribes assist health care providers by helping to administratively expedite an episode of care through the recording of patient information and updating patient records. Scribes are trained but non-licensed professionals, often deployed in emergency departments and outpatient clinic settings, that observe and document patient encounters but do not participate in clinical care.
Interventions
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Scribes
Section 507 of the MISSION Act of 2018 mandates a two-year pilot of medical scribes in VA specialty clinics and emergency departments. Medical scribes assist health care providers by helping to administratively expedite an episode of care through the recording of patient information and updating patient records. Scribes are trained but non-licensed professionals, often deployed in emergency departments and outpatient clinic settings, that observe and document patient encounters but do not participate in clinical care.
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
The VA Office of Veterans Access to Care developed a list of 32 interested VAMCs based on email surveying, which were categorized based on location (urban, rural), desired scribe deployment (ED, specialty care), and underserved (based on high new patient specialty care wait times). 12 VAMCs were then randomly selected for the treatment, accounting for the requirements of the law, OVAC preferences, and site capabilities, with the remainder used as comparison sites.
ALL
Yes
Sponsors
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US Department of Veterans Affairs
FED
VA Boston Healthcare System
FED
Responsible Party
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Melissa Garrido
Associate Director
Principal Investigators
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Steven Pizer, PhD
Role: PRINCIPAL_INVESTIGATOR
Boston VA Healthcare System
Locations
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Southern Arizona VA Health Care System
Tucson, Arizona, United States
Robley Rex VA Medical Center
Louisville, Kentucky, United States
Togus VA Medical Center
Augusta, Maine, United States
Fort Harrison VA Medical Center
Helena, Montana, United States
Manchester VA Medical Center
Manchester, New Hampshire, United States
East Orange VA Medical Center
East Orange, New Jersey, United States
Fargo VA Medical Center
Fargo, North Dakota, United States
Oklahoma City VA Medical Center
Oklahoma City, Oklahoma, United States
Audie L. Murphy VA Hospital
San Antonio, Texas, United States
Olin E. Teague Veterans' Medical Center
Temple, Texas, United States
Hampton VA Medical Center
Hampton, Virginia, United States
Louis A. Johnson VA Medical Center
Clarksburg, West Virginia, United States
Countries
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References
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Pearson, E., Frakt, A., & Pizer, S. (2018, December). Medical Scribes, Productivity, and Satisfaction. Partnered Evidence-based Policy Resource Center Policy Brief, 3(2).
Palani S, Saeed I, Legler A, Sadej I, MacDonald C, Kirsh SR, Pizer SD, Shafer PR. Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics. J Gen Intern Med. 2023 Jul;38(Suppl 3):878-886. doi: 10.1007/s11606-023-08114-6. Epub 2023 Jun 20.
Other Identifiers
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VA QUERI PEC #16-001
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
PEPReC Protocol #2019-001
Identifier Type: -
Identifier Source: org_study_id
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