Ignite Creation Date:
2024-05-06 @ 8:10 PM
Last Modification Date:
2024-10-26 @ 3:21 PM
Study NCT ID:
NCT06277323
Status:
ACTIVE_NOT_RECRUITING
Last Update Posted:
2024-02-26
First Post:
2024-02-01
Brief Title:
UCLA Health Patient Cardiology Care Gaps
Sponsor:
University of California Los Angeles
Organization:
University of California Los Angeles
Study Overview
Official Title:
UCLA Health Patient Cardiology Care Gaps
Status:
ACTIVE_NOT_RECRUITING
Status Verified Date:
2024-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This is a prospective randomized clinical trial evaluating how two behaviorally-informed interventions ie monthly report card and storyboard interventions impact physician behavior with the goal of closing care gaps in preventive care and disease management
In particular the monthly report card intervention seeks to elevate physicians intentions to close their patients care gaps while the storyboard intervention seeks to prompt action by making patients care gaps salient The trial investigates the separate and joint impacts of the proposed behaviorally-informed interventions on encouraging physicians to close their patients care gaps
In particular the monthly report card intervention seeks to elevate physicians intentions to close their patients care gaps while the storyboard intervention seeks to prompt action by making patients care gaps salient The trial investigates the separate and joint impacts of the proposed behaviorally-informed interventions on encouraging physicians to close their patients care gaps
Detailed Description:
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 ie 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 patients 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 patients 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
Monthly performance feedback emails will include physicians performance on eight cardiology care gaps their projected earnings in the current quarter and their earnings in the previous quarter Care gaps include the following 1 statin or PCSK9 inhibitor use 2 aspirin use 3 beta blocker use 4 angiotensin-converting enzyme inhibitors angiotensin II receptor blockers or angiotensin receptor-neprilysin inhibitor use 5 mineralocorticoid receptor antagonist use 6 SGLT2i 7 average HCCRAF score and 8 blood pressure control
Analysis Plan
The investigators will use patient-level linear regression models where the response is a 10 indicator of whether the patient has completed any of the open care gaps with cluster-robust standard errors at the physician level
The primary regression model will look at the main effect of the report card intervention and the storyboard intervention
In a secondary regression we will investigate the joint impact of the two interventions including a report card x storyboard interaction
Control variables include
Patient-level care gap closure ie whether patients closed any of their open care gaps excluding HCCRAF score during the six months before the intervention delivery For patients who were not in a given physicians panel as of six months before the experiment mean values across the panel will be imputed
Physician characteristics gender years out from training subspecialty training within cardiology and panel size
Patient age If there will be a missing value the investigators will replace it with the mean and add a dummy variable to indicate patients with missing age
Indicators for patient raceethnicity Black non-Hispanic Hispanic Asian non-Hispanic white non-Hispanic othermixed unknown
Indicators for patient gender male female otherunknown
Indicators for patient 5-digit zip code all zip codes outside of California will be collapsed into one group
Indicators for patient insurance type Self-payuninsured Medicaid Medicare Advantage Medicare Fee For Service Commercial VA Other
The investigators will conduct subgroup analyses based on
Whether the patient is female or male
Whether the patient is white non-hispanic or racialethnic minority
Whether the patient is 65 including 65 or below 65 years of age
Distance from patients place of residence to their cardiologists clinic
Whether the patient has commercial or non-commercial insurance
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 ie 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 patients 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 patients 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
Monthly performance feedback emails will include physicians performance on eight cardiology care gaps their projected earnings in the current quarter and their earnings in the previous quarter Care gaps include the following 1 statin or PCSK9 inhibitor use 2 aspirin use 3 beta blocker use 4 angiotensin-converting enzyme inhibitors angiotensin II receptor blockers or angiotensin receptor-neprilysin inhibitor use 5 mineralocorticoid receptor antagonist use 6 SGLT2i 7 average HCCRAF score and 8 blood pressure control
Analysis Plan
The investigators will use patient-level linear regression models where the response is a 10 indicator of whether the patient has completed any of the open care gaps with cluster-robust standard errors at the physician level
The primary regression model will look at the main effect of the report card intervention and the storyboard intervention
In a secondary regression we will investigate the joint impact of the two interventions including a report card x storyboard interaction
Control variables include
Patient-level care gap closure ie whether patients closed any of their open care gaps excluding HCCRAF score during the six months before the intervention delivery For patients who were not in a given physicians panel as of six months before the experiment mean values across the panel will be imputed
Physician characteristics gender years out from training subspecialty training within cardiology and panel size
Patient age If there will be a missing value the investigators will replace it with the mean and add a dummy variable to indicate patients with missing age
Indicators for patient raceethnicity Black non-Hispanic Hispanic Asian non-Hispanic white non-Hispanic othermixed unknown
Indicators for patient gender male female otherunknown
Indicators for patient 5-digit zip code all zip codes outside of California will be collapsed into one group
Indicators for patient insurance type Self-payuninsured Medicaid Medicare Advantage Medicare Fee For Service Commercial VA Other
The investigators will conduct subgroup analyses based on
Whether the patient is female or male
Whether the patient is white non-hispanic or racialethnic minority
Whether the patient is 65 including 65 or below 65 years of age
Distance from patients place of residence to their cardiologists clinic
Whether the patient has commercial or non-commercial insurance
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None