The Effect of Personalized Report Cards and Bottom-up Framing on PCCE Performance and Attitudes
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 233
- 试验地点
- 3
- 主要终点
- Physician Behavior: Rate of Engagement with Resources in First Email
研究概览
简要总结
As part of UCLA Health's commitment to developing an integrated health system built on a foundation of physician-led, team-based primary care, the Department of Medicine (DOM) implemented a performance-based incentive plan called the Primary Care Clinical Excellence (PCCE) Incentive Plan.
The UCLA Health DOM Quality team is leading the implementation and evaluation of this incentive plan across the UCLA Health primary care network, with the primary goal to immediately produce improvements in the quality of primary care. In order to rigorously measure the most efficacious ways to frame and communicate information about the quality improvement (QI) program, the DOM Quality team has partnered with the UCLA Anderson School of Management.
Understanding the factors that motivate physicians to deliver high quality primary care will provide pivotal insights into the successful implementation of performance based programs nationwide.
详细描述
The investigators will use a communication strategy that leverages behavioral principles to motivate providers to improve in all four of the evaluated domains of the PCCE program: clinical quality, professional participation, patient experience, and risk coding.
The investigators will implement a three-arm experimental communication campaign that includes quarterly emails and quarterly survey messages. The communication strategies will utilize motivation and behavior change theories to improve physician performance in the program and attitudes towards the program. In particular, the investigators will test the independent and joint effects of communicating with physicians (a) personalized performance feedback and (b) the "co-creation" of the program (i.e., sharing how physician feedback informed the program design).
The investigators will randomly assign eligible physicians to one of the three experimental arms, stratified by overall baseline performance (the total percent allocated in the PCCE program for the April, May, June 2023 quarter), specialty (based on classification as Adult or Adult/Peds), and contract (based on classification as DOM or PCN (CPN/EIMG)).
The investigators will evaluate whether arm 3 differs from arm 1 in terms of the measures listed in the Outcome Measures section. If this comparison is statistically significant, the investigators will next compare arms 3 vs. 2 and arms 2 vs. 1.
Analysis plan
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Primary care physicians within the UCLA Health Department of Medicine Primary Care Network that are eligible for the PCCE Incentive program as of October 1,
- •Physicians with the clinical full-time employee level (FTE) of ≥ 40% as of October 1, 2023
- •Physicians with panel size >50 patients as of October 1, 2023
排除标准
- •Physicians classified as Pediatrics will be excluded from data analysis given the structural differences in health maintenance guidelines for children.
- •Physicians classified as Urgent Care will be excluded from data analysis given the structural differences in their performance evaluation. They are all in Arm
- •Physicians who participate in the design of this experiment will be excluded from analysis.
研究组 & 干预措施
Arm 1: Standard Communication Arm
Quarterly email communication:
Quarterly standard communication via email providing a link to physicians to check their PCCE program performance over the prior quarter, and a link to access the PCCE dashboard. The email will also include a link to resources. Starting with the email communication in February 2024, there will be a reminder email sent two weeks after the first email with the same content.
Quarterly survey:
Quarterly standard communication via survey with questions about physician attitudes and beliefs.
干预措施: Standard Communication Email (Behavioral)
Arm 2: Personalized Report Card
Quarterly email communication:
Quarterly personalized communication via email providing individualized performance metrics to physicians for the PCCE program from the prior quarter. All the links in the Arm 1 emails will be included in Arm 2 emails. Starting with the email communication in February 2024, there will be a reminder email sent two weeks after the first email with the same content.
Quarterly survey:
Quarterly standard communication via survey with the same questions about physician attitudes and beliefs as in Arm 1.
干预措施: Personalized Report Card Email (Behavioral)
Arm 3: Personalized Report Card + Bottom-Up Framing
Quarterly email communication as in Arm 2. Bottom-up intervention: The quarterly email communication will also describe the ways in which the PCCE program and its features were informed by physician feedback and recommendations.
Quarterly survey: The quarterly survey will include information about the ways in which the PCCE program and its features were informed by physician feedback and recommendations. Physicians will respond to the same questions about physician attitudes and beliefs as in Arms 1 and 2.
干预措施: Personalized Report Card Email (Behavioral)
Arm 3: Personalized Report Card + Bottom-Up Framing
Quarterly email communication as in Arm 2. Bottom-up intervention: The quarterly email communication will also describe the ways in which the PCCE program and its features were informed by physician feedback and recommendations.
Quarterly survey: The quarterly survey will include information about the ways in which the PCCE program and its features were informed by physician feedback and recommendations. Physicians will respond to the same questions about physician attitudes and beliefs as in Arms 1 and 2.
干预措施: Bottom-Up Framing (Behavioral)
结局指标
主要结局
Physician Behavior: Rate of Engagement with Resources in First Email
时间窗: 1 week
Whether physicians click through to access the "PCCE Resources and Improvement Strategies", for which a link is provided via quarterly report card emails. The time frame is one week after the first email was sent, as a binary indicator.
次要结局
- Rate of Citizenship Behavior(2 weeks)
- Physician Program-Related Attitudes and Perceptions(12 months)
- Physician Workplace Attitudes(12 months)
- Rate of Overall Resource Engagement(12 months)
- Domain-Specific and Aggregate PCCE Performance(9 months)
研究者
Richard K. Leuchter, MD
Clinical Instructor
University of California, Los Angeles