Evaluation of Our Practice Advisory (OPA) Interventions on Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) Short Interval Ordering
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Enrollment
- 384
- Locations
- 1
- Primary Endpoint
- Change in Frequency of Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) Ordered within 30 days of Prior Results
Study Overview
Brief Summary
Our Practice Advisory (OPA) are essential tools in clinical decision-making. The alerts are designed to guide providers towards evidence-based practices and improve patient outcomes. The focus of this initiative is on Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) testing, with the goal of addressing unnecessary repeat testing within a 30-day timeframe, which rarely yields significant new insights. Although randomization occurs at the patient level, the primary outcome of this study focuses on provider behavior and decision-making.
By focusing on this specific intervention, the study aims to optimize resource use, align test ordering with evidence-based guidelines, and support improved patient outcomes. The results of this evaluation will help refine OPAs and guide broader strategies for implementing clinical decision support tools across healthcare systems.
Detailed Description
The purpose of this Quality Improvement (QI) initiative is to evaluate the impact of a randomized Our Practice Advisory (OPA) intervention on physician ordering behavior of Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) tests within a 30-day interval from the prior test. The OPA will fire when an A1c or TSH are ordered within 30 days of a prior result (these short-interval tests are widely considered unnecessary) and will ask providers to reconsider the order. This study will evaluate the effectiveness of this intervention by randomizing patients 1:1 such that physicians caring for the patient will either (1) receive the OPA or (2) not receive the OPA if the providers order a short-interval test. This study is being conducted for a primary QI intent, as the results will (1) dictate if the short-interval OPA should be implemented across all patients, and (2) if this short-interval OPA should be applied to other labs aside from A1c and TSH. In these ways, the purpose of this study is to directly inform health system operations.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- Double (Care Provider, Investigator)
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •18 years or older
- •Inpatient or observation stays within UCLA Health System hospitals
- •Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) ordered, AND this lab was ordered and resulted within the prior 30 days
Exclusion Criteria
- •Have an A1c or TSH ordered and do not have a result for one of these labs in the prior 30 days
Arms & Interventions
Control Group
Providers in this group will not receive a Our Practice Advisory (OPA) through the Electronic Health Record (EHR) system when ordering Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) tests. This group represents the current standard of care, with no additional prompts or alerts implemented.
OPA Intervention Group
Providers in this group will receive a Our Practice Advisory (OPA) through the electronic health record (EHR) system when ordering Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) tests. The OPA will prompt providers to reconsider the test if it was ordered within the previous 30 days, aligning with evidence-based guidelines to reduce unnecessary testing.
Intervention: OPA (Behavioral)
Outcomes
Primary Outcomes
Change in Frequency of Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) Ordered within 30 days of Prior Results
Time Frame: Study month 6
This measure evaluates the impact of a randomized Our Practice Advisory (OPA) intervention on the frequency of Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) tests ordered within 30 days of prior results. Data will be extracted from the UCLA Health Electronic Health Record (EHR) system using a structured query to identify qualifying test orders. Logistic regression will be used to compare the likelihood of A1c or TSH orders within the 30 days between the intervention and control group, adjusting for patient age, sex, and comorbidities. Clustering by providers will be accounted for.
Secondary Outcomes
No secondary outcomes reported
Investigators
Catherine A. Sarkisian
Associate Professor of Medicine
University of California, Los Angeles