Application of Behavioral Economics to Improve eConsult

Quality of Health Care Clinical Trial

Official title:

Application of Behavioral Economics to Improve the Quality and Value of eConsult Specialty Reviews

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03784950
• Other study ID #: HS-17-00077
• Status: Completed
• Phase: N/A
• Start date: March 1, 2017
• Est. completion date: August 31, 2018

Study information

• Verified date: December 2018
• Source: University of Southern California
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Using behavioral economics, the study objective is to increase the efficiency, quality, and timeliness of care for Los Angeles County (LAC) Department of Health Services (DHS) patients by nudging specialists toward more effective use of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care.

Description:

Historically, the Los Angeles County (LAC) Department of Health Services (DHS) Safety Net system has faced challenges in delivering specialty services that are timely, geographically equitable, and coordinated in a patient centered manner. Recently, LACDHS improved infrastructure through implementation of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care. The study investigators will conduct a pragmatic randomized trial with the goal of increasing the efficiency, quality, and timeliness of care for LACDHS patients by nudging specialists toward more effective use of eConsult. If successful, these nudges may reduce the number and increase the value of face-to-face consults.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 220
• Est. completion date: August 31, 2018
• Est. primary completion date: August 31, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• LACDHS providers who are eConsult system users

Exclusion Criteria:

Related Conditions & MeSH terms

• Quality of Health Care

Intervention

Behavioral:
• Rating tool
eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)
• Feedback
eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)

Locations

Country	Name	City	State
United States	Los Angeles County Department of Health Services	Los Angeles	California

Sponsors (2)

Lead Sponsor	Collaborator
University of Southern California	Los Angeles County Department of Public Health

Country where clinical trial is conducted

United States, 

References & Publications (2)

Barnett ML, Yee HF Jr, Mehrotra A, Giboney P. Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists. Health Aff (Millwood). 2017 Mar 1;36(3):492-499. doi: 10.1377/hlthaff.2016.1283. — View Citation

Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis. JAMA Intern Med. 2018 Jun 1;178(6):782-789. doi: 10.1001/jamainternmed.2018.0738. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Rating - Medical Decision Making	Peers' ratings of Medical Decision Making in Specialists' responses to PCPs	Baseline to Post-Intervention, up to 12 months
Primary	Rating - Application of Expected Practices	Peers' ratings of Expected Practices in Specialists' responses to PCPs	Baseline to Post-Intervention, up to 12 months
Primary	Rating - Relationship Building	Peers' ratings Relationship Building in Specialists' responses to PCPs	Baseline to Post-Intervention, up to 12 months
Primary	Rating - Expert Elicitation	Peers' ratings of Specialists' skill in elicitation of information from PCPs	Baseline to Post-Intervention, up to 12 months
Primary	Rating - Educational Value	Peers' ratings of Educational Value of eConsults	Baseline to Post-Intervention, up to 12 months