Clinical Trial Details
— Status: Active, not recruiting
Administrative data
| NCT number |
NCT06277323 |
| Other study ID # |
Cardio |
| Secondary ID |
|
| Status |
Active, not recruiting |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
January 30, 2024 |
| Est. completion date |
July 30, 2025 |
Study information
| Verified date |
February 2024 |
| Source |
University of California, Los Angeles |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
This is a prospective randomized clinical trial evaluating how two behaviorally-informed
interventions (i.e., monthly report card and storyboard interventions) impact physician
behavior, with the goal of closing care gaps in preventive care and disease management.
In particular, the monthly report card intervention seeks to elevate physicians' intentions
to close their patients' care gaps, while the storyboard intervention seeks to prompt action
by making patients' care gaps salient. The trial investigates the separate and joint impacts
of the proposed behaviorally-informed interventions on encouraging physicians to close their
patients' care gaps.
Description:
Despite the existence of evidence-based clinical guidelines on how to manage the health of
patients with cardiovascular disease that have been shown to improve cardiac function and
survival, significant gaps in care persist and optimal medical therapy is often
under-utilized. For example, guideline-directed medical therapy (GDMT), statin and aspirin
therapy, and blood pressure control are cornerstones of effective management of patients with
cardiovascular disease or heart failure. However, current dashboard data indicate that within
the UCLA Health system, these medical therapies remain under-utilized.
As part of the quality improvement (QI) initiative sponsored by the Division of Cardiology at
UCLA Health, this trial will examine the independent and joint impacts on care gap closure of
(1) sending monthly behaviorally-informed emails to physicians with personalized feedback on
care gap performance and (2) enhancing the visibility of the open care gaps in the electronic
health record upon patient encounter.
Eligible physicians (i.e., UCLA Health Cardiologists) will be randomized to one of four
conditions based on a 2 (monthly report card intervention: receive vs. no receive) x 2
(storyboard intervention: receive vs not receive) between-subjects design:
- In the no intervention (control) condition, physician participants will receive
quarterly emails with their performance report card (status quo).
- In the monthly report card only condition, behaviorally-informed monthly emails will be
sent to inform physicians of their performance and elevate physicians' intentions to get
more of their patients to close care gaps.
- In the storyboard only condition, the visibility of care gap banners in the electronic
health record (EHR) will be enhanced, which will promptly remind physicians of each
patient's care gaps at the start of a patient-physician encounter.
- In the monthly report card and storyboard condition, physicians will receive
behaviorally-informed monthly emails and be reminded of each patient's care gaps via the
EHR storyboard during patient-physician encounters.
The trial will include physicians participating in an existing UCLA incentive program, as of
October 1, 2023, who have a panel size of above 50 patients. In August 2024, new physicians
who are eligible for the incentive program and have at least 50 patients in the panel will be
randomly assigned into one of the four conditions and become part of the study sample.
Randomization will balance for physicians' baseline performance, subspecialty training, years
out from training, and estimated panel size.
Monthly performance feedback emails will include physicians' performance on eight cardiology
care gaps, their projected earnings in the current quarter and their earnings in the previous
quarter. Care gaps include the following: (1) statin or PCSK9 inhibitor use, (2) aspirin use,
(3) beta blocker use, (4) angiotensin-converting enzyme inhibitors, angiotensin II receptor
blockers, or angiotensin receptor-neprilysin inhibitor use, (5) mineralocorticoid receptor
antagonist use, (6) SGLT2i, (7) average HCC/RAF score, and (8) blood pressure control.
Analysis Plan:
- The investigators will use patient-level linear regression models, where the response is
a 1/0 indicator of whether the patient has completed any of the open care gaps, with
cluster-robust standard errors at the physician level.
- The primary regression model will look at the main effect of the report card
intervention and the storyboard intervention.
- In a secondary regression, we will investigate the joint impact of the two
interventions, including a report card x storyboard interaction.
Control variables include:
- Patient-level care gap closure (i.e., whether patients closed any of their open care
gaps, excluding HCC/RAF score, during the six months before the intervention delivery).
For patients who were not in a given physician's panel as of six months before the
experiment, mean values across the panel will be imputed.
- Physician characteristics (gender, years out from training, subspecialty training within
cardiology) and panel size.
