Medical Scribes Clinical Trial
Official title:
Evaluation of the Use of Medical Scribes on Provider Efficiency, Patient Satisfaction, and Wait Times in VAMC Emergency Departments and Specialty Care Clinics
| Verified date | August 2022 |
| Source | VA Boston Healthcare System |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | |
| Study type | Interventional |
Background and study aims: Medical scribes are trained paraprofessionals that assist providers with documenting patient encounters. Prior evidence suggests that scribes may be effective in increasing provider productivity and satisfaction, and decreasing provider time spent on documentation without negatively affecting patient satisfaction. Section 507 of the MISSION Act of 2018 mandated a two-year pilot of medical scribes, which will begin in March 2020 in specialty clinics and emergency departments (EDs) of twelve VA Medical Centers (VAMCs) across the country. The aims of this study are to understand how the introduction of scribes and scribe training affect provider efficiency, patient and provider satisfaction, wait times, and daily patient volume in the VA context. 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
| Status | Completed |
| Enrollment | 12 |
| Est. completion date | July 1, 2022 |
| Est. primary completion date | July 1, 2022 |
| Accepts healthy volunteers | Accepts Healthy Volunteers |
| Gender | All |
| Age group | N/A and older |
| Eligibility | Inclusion Criteria: • Expression of interest by VAMC Exclusion Criteria: • Lack of appropriate site capabilities 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. |
| Country | Name | City | State |
|---|---|---|---|
| United States | Togus VA Medical Center | Augusta | Maine |
| United States | Louis A. Johnson VA Medical Center | Clarksburg | West Virginia |
| United States | East Orange VA Medical Center | East Orange | New Jersey |
| United States | Fargo VA Medical Center | Fargo | North Dakota |
| United States | Hampton VA Medical Center | Hampton | Virginia |
| United States | Fort Harrison VA Medical Center | Helena | Montana |
| United States | Robley Rex VA Medical Center | Louisville | Kentucky |
| United States | Manchester VA Medical Center | Manchester | New Hampshire |
| 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 | Southern Arizona VA Health Care System | Tucson | Arizona |
| Lead Sponsor | Collaborator |
|---|---|
| VA Boston Healthcare System | US Department of Veterans Affairs |
United States,
Pearson, E., Frakt, A., & Pizer, S. (2018, December). Medical Scribes, Productivity, and Satisfaction. Partnered Evidence-based Policy Resource Center Policy Brief, 3(2).
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Pay period work relative value-based provider efficiency | Pay period work relative value-based provider efficiency is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments | Approximately 42 months | |
| Primary | Pay period visit-based provider efficiency | Pay period visit-based provider efficiency is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments | Approximately 42 months | |
| Primary | Daily visit-based provider efficiency | Daily visit-based provider efficiency is measured using monthly-based provider efficiency, scaled by full-time-equivalent days; this is based on administrative data collected by the VA Corporate Data Warehouse in pay period increments | Approximately 42 months | |
| Primary | Days to completed consult | Days to completed consult is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments | Approximately 42 months | |
| Primary | Days to scheduled consult | Days to scheduled consult is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments | Approximately 42 months | |
| Primary | Unique patient volume | Unique patient volume is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments | Approximately 42 months | |
| Primary | Patient satisfaction | Patient satisfaction is measured using V-Signals survey data collected by the VA Office of Veterans Experience in pay period increments | Approximately 42 months |