Effect of Norms on Laboratory and Imaging Testing (ENLITen)

Not Applicable

Completed

• Conditions: Utilization; Laboratory, Hospital
• Interventions: Behavioral: Normative report card

• Registration Number: NCT02330289
• Lead Sponsor: University of Pennsylvania

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.

Study Timeline

• Study First Submitted: 2014-12-29
• Study First Submitted QC: 2014-12-30
• Study First Posted: 2015-01-01
• Study Start: 2015-12
• Primary Completion: 2016-06
• Study Completion: 2016-09
• Status Verified: 2023-04
• Last Update Submitted: 2023-04-03
• Last Update Posted: 2023-04-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 154

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.

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Exclusion Criteria

• Physicians-in-training pulled for weekend coverage or sick coverage will be excluded. Medical students will be excluded.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Report card arm	Normative report card	The intervention arm will receive an email report card describing their lab use compared to their peers as well as a link to a website visually tracking the team's daily ordering of common lab tests compared to the peer teams.

Primary Outcome Measures

Name	Time	Method
Routine laboratory tests/patient-day	6 months	the number of routine laboratory tests per patient-day ordered by the physicians-in-training

Secondary Outcome Measures

Name	Time	Method
Laboratory costs	6 months
Routine imaging tests/patient-day	6 months
Physicians' attitudes toward laboratory test use and receiving feedback	6 months	Focus groups