The Effect of Norms on Laboratory and Imaging Testing (ENLITen): a Pragmatic Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Utilization
- Sponsor
- University of Pennsylvania
- Enrollment
- 154
- Primary Endpoint
- Routine laboratory tests/patient-day
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief Summary
Studies suggest that some laboratory tests ordered for hospitalized patients are duplicative or have limited value. This study will evaluate a normative feedback intervention to reduce overuse of laboratory tests for hospitalized patients by internal medicine physicians-in-training.
Detailed Description
Past research has shown that 25% of diagnostic testing is duplicative or has limited value. Academic medical centers that employ physicians-in-training may find it particularly challenging to reduce low value testing due to a historical emphasis on extensive workups by trainees. Despite the increased emphasis on cost-consciousness in medical education, there is little existing research evaluating ways to optimize ordering behaviors of physicians-in-training. This study will evaluate a normative feedback intervention for internal medicine physicians-in-training to reduce overuse of routine laboratory tests for hospitalized patients. Physicians-in-training will be cluster-randomized into two arms: (1) those who receive report cards (intervention group), (2) those who will not receive report cards (control group). We will study the use of routine laboratory tests over a pre-intervention period of 1 week and a post-randomization period of 1 week. We will study physician attitudes about the real-time feedback dashboard with qualitative assessments in focus groups after the completion of the intervention.
Investigators
Kira Ryskina
Fellow, Division of General Internal Medicine
University of Pennsylvania
Eligibility Criteria
Inclusion Criteria
- •Any internal medicine physician-in-training scheduled to rotate through general medicine services at HUP during the study period will be included in the study.
Exclusion Criteria
- •Physicians-in-training pulled for weekend coverage or sick coverage will be excluded. Medical students will be excluded.
Outcomes
Primary Outcomes
Routine laboratory tests/patient-day
Time Frame: 6 months
the number of routine laboratory tests per patient-day ordered by the physicians-in-training
Secondary Outcomes
- Laboratory costs(6 months)
- Routine imaging tests/patient-day(6 months)
- Physicians' attitudes toward laboratory test use and receiving feedback(6 months)