Evaluation of the Use of Medical Scribes in VAMC Emergency Departments and Specialty Care Clinics
- Conditions
- Medical Scribes
- Interventions
- Other: Scribes
- Registration Number
- NCT04154462
- Lead Sponsor
- VA Boston Healthcare System
- Brief Summary
Background and study aims: Medical scribes are trained paraprofessionals that assist providers with documenting patient encounters. Prior evidence suggests that scribes may be effective in increasing provider productivity and satisfaction, and decreasing provider time spent on documentation without negatively affecting patient satisfaction. Section 507 of the MISSION Act of 2018 mandated a two-year pilot of medical scribes, which will begin in March 2020 in specialty clinics and emergency departments (EDs) of twelve VA Medical Centers (VAMCs) across the country. The aims of this study are to understand how the introduction of scribes and scribe training affect provider efficiency, patient and provider satisfaction, wait times, and daily patient volume in the VA context.
Who can participate? Urban and rural VAMCs willing to be assigned medical scribes for use in EDs or selected high wait time specialty clinics (cardiology, orthopedics).
What does the study involve? Four medical scribes will be assigned to each of the 12 VAMC sites randomized into treatment with the VA hiring half as new employees and contracting out for the remaining half. 30% of the scribes will be assigned to emergency departments and the other 70% will be assigned to specialty care. Remaining sites that expressed interest in the pilot but were not randomized treatment will be used as comparators. Provider productivity, patient volume, wait times, and patient satisfaction from the treated sites will be compared to baseline (pre-scribe) data as well as data from comparison sites.
What are the possible benefits and risks of participating? VAMCs where medical scribes are introduced may see gains in provider efficiency, reduced wait times, and increased patient satisfaction due to the shifting of administrative burdens associated with documenting patient encounters in electronic health records from providers to these trained professionals. The introduction of medical scribes could complicate patient encounters by making some patients and/or providers uncomfortable.
Where is the study run from? This study is being coordinated by the Partnered Evidence-based Policy Resource Center (PEPReC) at the VA Boston Healthcare System in collaboration with the VA Office of Veterans Access to Care (OVAC).
When is the study starting and how long is it expected to run for? March 2020 to February 2022
Who is funding the study? U.S. Veterans Health Administration
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 12
• Expression of interest by VAMC
• Lack of appropriate site capabilities
The VA Office of Veterans Access to Care developed a list of 32 interested VAMCs based on email surveying, which were categorized based on location (urban, rural), desired scribe deployment (ED, specialty care), and underserved (based on high new patient specialty care wait times). 12 VAMCs were then randomly selected for the treatment, accounting for the requirements of the law, OVAC preferences, and site capabilities, with the remainder used as comparison sites.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Treatment Scribes The VAMC sites randomized to the treatment arm are each expected to have four medical scribes, with two being VA employees and two being contractors, introduced into emergency departments or specialty clinics to assist providers during patient encounters.
- Primary Outcome Measures
Name Time Method Pay period visit-based provider efficiency Approximately 42 months Pay period visit-based provider efficiency is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
Days to completed consult Approximately 42 months Days to completed consult is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
Unique patient volume Approximately 42 months Unique patient volume is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
Patient satisfaction Approximately 42 months Patient satisfaction is measured using V-Signals survey data collected by the VA Office of Veterans Experience in pay period increments
Days to scheduled consult Approximately 42 months Days to scheduled consult is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
Pay period work relative value-based provider efficiency Approximately 42 months Pay period work relative value-based provider efficiency is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
Daily visit-based provider efficiency Approximately 42 months Daily visit-based provider efficiency is measured using monthly-based provider efficiency, scaled by full-time-equivalent days; this is based on administrative data collected by the VA Corporate Data Warehouse in pay period increments
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (12)
Fort Harrison VA Medical Center
🇺🇸Helena, Montana, United States
Southern Arizona VA Health Care System
🇺🇸Tucson, Arizona, United States
Togus VA Medical Center
🇺🇸Augusta, Maine, United States
Robley Rex VA Medical Center
🇺🇸Louisville, Kentucky, United States
Manchester VA Medical Center
🇺🇸Manchester, New Hampshire, United States
East Orange VA Medical Center
🇺🇸East Orange, New Jersey, United States
Fargo VA Medical Center
🇺🇸Fargo, North Dakota, United States
Oklahoma City VA Medical Center
🇺🇸Oklahoma City, Oklahoma, United States
Olin E. Teague Veterans' Medical Center
🇺🇸Temple, Texas, United States
Audie L. Murphy VA Hospital
🇺🇸San Antonio, Texas, United States
Louis A. Johnson VA Medical Center
🇺🇸Clarksburg, West Virginia, United States
Hampton VA Medical Center
🇺🇸Hampton, Virginia, United States