UCLA Health Patient Cardiology Care Gaps

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.