Clinical Trial Details
— Status: Enrolling by invitation
Administrative data
| NCT number |
NCT05413070 |
| Other study ID # |
IRB-22-1568 |
| Secondary ID |
|
| Status |
Enrolling by invitation |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
June 15, 2022 |
| Est. completion date |
December 31, 2023 |
Study information
| Verified date |
August 2023 |
| Source |
Carilion Clinic |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
As
Description:
Two common low-value services are related to acute low back pain. Choosing Wisely advises
avoiding the use of imaging during the first 6 weeks of low back pain (per the American
Academy of Family Physicians and other organizations). Similarly, Choosing Wisely advises
avoiding opioids in the treatment of low back pain until other alternatives have been
attempted (per the North American Spine Society). Together, overutilization of these two
services (imaging and opioids for low back pain) costs more than $500 annually, not including
downstream costs, and is a source of patient harm. In the state of Virginia, the Virginia
Center for Health Innovation has identified the two back pain measures as priority for
reducing as part of their 3-year intervention (Smarter Care Virginia):
https://www.vahealthinnovation.org/scv/
As a participant in Smarter Care Virginia (SCV), Carilion receives data showing each Carilion
Clinic clinician's performance on SCV measures, including the two back pain measures. For
example, Carilion receives a database that lists the clinician's name, department, number of
appropriate orders for each SCV measure made and the number of low-value orders for each SCV
measure made. Carilion (and the other 7 participating health systems) are asked to use this
information to generate quality improvement initiatives. We have designed a quality
improvement initiative focused on family and community medicine clinicians and the two back
pain measures.
First, we will use the most recent data provided by the SCV project (2020 and Q1-Q2 of 2021)
to rank FCM practices and clinicians by utilization of low-value back pain services, their
waste index, and impact score. We will identify from this ranking the top 5 to 10 performing
practices and the bottom 5 to 10 performing practices. If there are any outlier clinicians
who are bottom performing (ie: provide the most low-value services or have the highest impact
score) but who do not fall among the bottom performing practices, we will consider including
their practice among the bottom 5 to 10.
We will survey clinicians in top and bottom performing practices to learn more about their
knowledge, perceptions, and practice workflow related to the two back pain measures. They
will also be asked about their trust in data measures. No identifying information will be
collected from clinicians in the survey.
From what we learn from survey data, we will design up to four brief education points to be
communicated during regular practice quality improvement meetings with population health
managers.
Prior to the delivery of quality improvement education about back pain measures, we will
obtain an EMR report for the top and bottom performing practices showing utilization rate of
both back pain measures. We will also conduct a chart review (Epic) to identify indication
for provision of the back pain services that could not be detected in claims data or Epic
data. This addresses a common concern of clinicians - that clinical nuance is not being
detected and low value care is being over-assigned. The Epic reports and chart reviews will
continue monthly for the first 3 months and then at months 6 and 12.
