<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03784950</url>
  </required_header>
  <id_info>
    <org_study_id>HS-17-00077</org_study_id>
    <nct_id>NCT03784950</nct_id>
  </id_info>
  <brief_title>Application of Behavioral Economics to Improve eConsult</brief_title>
  <official_title>Application of Behavioral Economics to Improve the Quality and Value of eConsult Specialty Reviews</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Southern California</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Los Angeles County Department of Public Health</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Southern California</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Using behavioral economics, the study objective is to increase the efficiency, quality, and&#xD;
      timeliness of care for Los Angeles County (LAC) Department of Health Services (DHS) patients&#xD;
      by nudging specialists toward more effective use of eConsult, a web-based consultation and&#xD;
      communication portal for Primary Care Providers (PCPs) and specialists, improving access for&#xD;
      patients in greatest need of specialty care.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Historically, the Los Angeles County (LAC) Department of Health Services (DHS) Safety Net&#xD;
      system has faced challenges in delivering specialty services that are timely, geographically&#xD;
      equitable, and coordinated in a patient centered manner. Recently, LACDHS improved&#xD;
      infrastructure through implementation of eConsult, a web-based consultation and communication&#xD;
      portal for Primary Care Providers (PCPs) and specialists, improving access for patients in&#xD;
      greatest need of specialty care. The study investigators will conduct a pragmatic randomized&#xD;
      trial with the goal of increasing the efficiency, quality, and timeliness of care for LACDHS&#xD;
      patients by nudging specialists toward more effective use of eConsult. If successful, these&#xD;
      nudges may reduce the number and increase the value of face-to-face consults.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">March 1, 2017</start_date>
  <completion_date type="Actual">August 31, 2018</completion_date>
  <primary_completion_date type="Actual">August 31, 2018</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Sequential Assignment</intervention_model>
    <primary_purpose>Health Services Research</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Rating - Medical Decision Making</measure>
    <time_frame>Baseline to Post-Intervention, up to 12 months</time_frame>
    <description>Peers' ratings of Medical Decision Making in Specialists' responses to PCPs</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Rating - Application of Expected Practices</measure>
    <time_frame>Baseline to Post-Intervention, up to 12 months</time_frame>
    <description>Peers' ratings of Expected Practices in Specialists' responses to PCPs</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Rating - Relationship Building</measure>
    <time_frame>Baseline to Post-Intervention, up to 12 months</time_frame>
    <description>Peers' ratings Relationship Building in Specialists' responses to PCPs</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Rating - Expert Elicitation</measure>
    <time_frame>Baseline to Post-Intervention, up to 12 months</time_frame>
    <description>Peers' ratings of Specialists' skill in elicitation of information from PCPs</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Rating - Educational Value</measure>
    <time_frame>Baseline to Post-Intervention, up to 12 months</time_frame>
    <description>Peers' ratings of Educational Value of eConsults</description>
  </primary_outcome>
  <number_of_arms>3</number_of_arms>
  <enrollment type="Actual">220</enrollment>
  <condition>Quality of Health Care</condition>
  <arm_group>
    <arm_group_label>Rating tool only</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Rating eConsults from peer specialists in first phase</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Feedback only</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Receiving feedback from peer specialists in first phase</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Rating Tool plus Feedback</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Both rating and feedback in second phase.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Rating tool</intervention_name>
    <description>eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)</description>
    <arm_group_label>Rating Tool plus Feedback</arm_group_label>
    <arm_group_label>Rating tool only</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Feedback</intervention_name>
    <description>eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)</description>
    <arm_group_label>Feedback only</arm_group_label>
    <arm_group_label>Rating Tool plus Feedback</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  LACDHS providers who are eConsult system users&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  None&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Daniella Meeker, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Southern California</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Los Angeles County Department of Health Services</name>
      <address>
        <city>Los Angeles</city>
        <state>California</state>
        <zip>90012</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Barnett ML, Yee HF Jr, Mehrotra A, Giboney P. Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists. Health Aff (Millwood). 2017 Mar 1;36(3):492-499. doi: 10.1377/hlthaff.2016.1283.</citation>
    <PMID>28264951</PMID>
  </reference>
  <reference>
    <citation>Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis. JAMA Intern Med. 2018 Jun 1;178(6):782-789. doi: 10.1001/jamainternmed.2018.0738.</citation>
    <PMID>29801079</PMID>
  </reference>
  <verification_date>December 2018</verification_date>
  <study_first_submitted>December 5, 2018</study_first_submitted>
  <study_first_submitted_qc>December 20, 2018</study_first_submitted_qc>
  <study_first_posted type="Actual">December 24, 2018</study_first_posted>
  <last_update_submitted>December 20, 2018</last_update_submitted>
  <last_update_submitted_qc>December 20, 2018</last_update_submitted_qc>
  <last_update_posted type="Actual">December 24, 2018</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>University of Southern California</investigator_affiliation>
    <investigator_full_name>Daniella Meeker</investigator_full_name>
    <investigator_title>Assistant Professor</investigator_title>
  </responsible_party>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03784950
org study id: HS-17-00077
nct id: NCT03784950
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Using behavioral economics, the study objective is to increase the efficiency, quality, and
      timeliness of care for Los Angeles County (LAC) Department of Health Services (DHS) patients
      by nudging specialists toward more effective use of eConsult, a web-based consultation and
      communication portal for Primary Care Providers (PCPs) and specialists, improving access for
      patients in greatest need of specialty care.
Historically, the Los Angeles County (LAC) Department of Health Services (DHS) Safety Net
      system has faced challenges in delivering specialty services that are timely, geographically
      equitable, and coordinated in a patient centered manner. Recently, LACDHS improved
      infrastructure through implementation of eConsult, a web-based consultation and communication
      portal for Primary Care Providers (PCPs) and specialists, improving access for patients in
      greatest need of specialty care. The study investigators will conduct a pragmatic randomized
      trial with the goal of increasing the efficiency, quality, and timeliness of care for LACDHS
      patients by nudging specialists toward more effective use of eConsult. If successful, these
      nudges may reduce the number and increase the value of face-to-face consults.
allocation: Randomized
intervention model: Sequential Assignment
primary purpose: Health Services Research
masking: None (Open Label)
measure: Rating - Medical Decision Making
time frame: Baseline to Post-Intervention, up to 12 months
description: Peers' ratings of Medical Decision Making in Specialists' responses to PCPs
measure: Rating - Application of Expected Practices
time frame: Baseline to Post-Intervention, up to 12 months
description: Peers' ratings of Expected Practices in Specialists' responses to PCPs
measure: Rating - Relationship Building
time frame: Baseline to Post-Intervention, up to 12 months
description: Peers' ratings Relationship Building in Specialists' responses to PCPs
measure: Rating - Expert Elicitation
time frame: Baseline to Post-Intervention, up to 12 months
description: Peers' ratings of Specialists' skill in elicitation of information from PCPs
measure: Rating - Educational Value
time frame: Baseline to Post-Intervention, up to 12 months
description: Peers' ratings of Educational Value of eConsults
arm group label: Rating tool only
arm group type: Experimental
description: Rating eConsults from peer specialists in first phase
arm group label: Feedback only
arm group type: Experimental
description: Receiving feedback from peer specialists in first phase
arm group label: Rating Tool plus Feedback
arm group type: Experimental
description: Both rating and feedback in second phase.
intervention type: Behavioral
intervention name: Rating tool
description: eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)
arm group label: Rating Tool plus Feedback
arm group label: Rating tool only
intervention type: Behavioral
intervention name: Feedback
description: eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)
arm group label: Feedback only
arm group label: Rating Tool plus Feedback
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Daniella Meeker, PhD
role: Principal Investigator
affiliation: University of Southern California
facility: 
country: United States
citation: Barnett ML, Yee HF Jr, Mehrotra A, Giboney P. Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists. Health Aff (Millwood). 2017 Mar 1;36(3):492-499. doi: 10.1377/hlthaff.2016.1283.
PMID: 28264951
citation: Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis. JAMA Intern Med. 2018 Jun 1;178(6):782-789. doi: 10.1001/jamainternmed.2018.0738.
PMID: 29801079
responsible party type: Principal Investigator
investigator affiliation: University of Southern California
investigator full name: Daniella Meeker
investigator title: Assistant Professor
sharing ipd: No