A Randomized Controlled Trial of Two Ambient Artificial Intelligence Scribe Technologies to Improve Documentation Efficiency and Reduce Physician Burnout
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 238
- 试验地点
- 2
- 主要终点
- Change in the time in notes per note
研究概览
简要总结
This is a three-arm pragmatic RCT of 238 outpatient physicians at a large academic health system, randomized 1:1:1 to one of two AI scribe tools or a usual-care control group. The two-month study will observe and compare the effects of each tool prior to system-wide roll out of selected tool (anticipated Spring 2025). We will use covariate-constrained randomization to balance the arms in terms of physician baseline time in notes, survey-measured level of burnout, and clinic days per week.
The primary purpose of the initiative is to improve quality, efficiency, and business operations at University of California, Los Angeles (UCLA) Health, and this initiative is not being done for research purposes. The results of this operational initiative will inform the widespread roll out of AI scribe tools across all providers within the UCLA Health System. Nevertheless, the UCLA study team plans to rigorously examine and publish the impact of this intervention across the health system, which is why the study team pre-registered the initiative.
详细描述
This study will assess operational-oriented outcomes across all groups. Notably, all groups will eventually receive all interventions over time in this observational study of a randomized roll out of a QI initiative. Moreover, the primary purpose of this initiative is operational. In other words, based on the results of this initiative, one of these tools will be eventually selected and operationalized widely across the health system.
Enrolled participants are randomized to one of three groups. Randomization was needed to overcome secular trends, seasonal and holiday effects in December, and other factors confounding the relationship between exposure to the AI tools and the outcomes.
The primary aim of this study is to evaluate the impact of two ambient AI scribe technologies on clinician change from baseline time spent on EHR documentation, comparing each scribe to a control group. Secondary objectives include assessing the AI scribes' impact on clinician metrics such as burnout, physician satisfaction, and productivity. Additionally, the study team intends to perform an economic evaluation analysis of the tools to guide business decision making. The study team will also analyze physician reported effects of the AI tools on patient safety, equity, and any unintended consequences of the initiative.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- Single (Participant)
盲法说明
The outpatient physicians are not told which tool that they are assigned to.
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Ambulatory care physicians within the UCLA Health system who held at least one half-day of clinic per week
排除标准
- •Trainee providers (e.g., residents, medical students) and allied healthcare professionals (e.g., RNs, PAs)
- •Attendings who work exclusively with trainees
研究组 & 干预措施
Nabla, Vendor of virtual AI scribe technology
Participants in this arm will utilize AI scribe tools from Nabla and will continue their usual clinical documentation processes, supported by the scribe software, which integrates with the EHR and automatically adds the generated text to the note. The Nabla AI scribe tool is transcriptional and does not provide clinical decision support.
干预措施: Use Nabla AI Scribe tool provided (Other)
Vendor B of virtual AI scribe technology
Participants in this arm will utilize AI scribe tools from Vendor B and will continue their usual clinical documentation processes, supported by the scribe software, which integrates with the EHR and automatically adds the generated text to the note. The AI scribe tool is transcriptional and does not provide clinical decision support.
干预措施: Use AI Scribe tool provided by Vendor B (Other)
No Scribe
Participants in this arm will not have access to AI scribe tools and will continue their usual clinical documentation processes
结局指标
主要结局
Change in the time in notes per note
时间窗: Study month 2
The primary outcome measure is the change in the time in notes per note in the second month of the trial from a retrospective baseline six months prior to enrollment. This change will be computed on the natural log scale. No patient level information will be collected for this outcome measure.
Change in the Time in Notes Per Note
时间窗: Study month 2
The primary outcome measure is the change in provider mean time in notes per note in the second month of the trial from the providers baseline mean time in notes per note for the six months prior to enrollment. This change will be computed on the natural log scale. No patient level information will be collected for this outcome measure.
次要结局
- Provider Burnout Score(Study month 2)
- Change in clinic turnover rate(Study month 2)
- Provider Satisfaction Scores(Study month 2)
- Change in provider RVU(Study month 2)
- Change in EHR Signal (Activity) Data - Pajama Time(Study month 2)
- Change in EHR Signal (Activity) Data - Time outside scheduled hours(Study month 2)
- Change in EHR Signal (Activity) Data - Number of unscheduled days(Study month 2)
- Provider Task Load Score(Study month 2)
- Provider Professional Fulfillment(Study month 2)
- Number of Physicians Who Are Considered Detractors, Passive, or Promoters(Study month 2)
- Change in Provider RVU(Study month 2)
- Change in EHR Signal (Activity) Data - Time Outside Scheduled Hours(Study month 2)
- Change in EHR Signal (Activity) Data - Time on Unscheduled Days(Study month 2)
研究者
John N. Mafi, MD, MPH
Associate Professor of Medicine
University of California, Los Angeles