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A Statewide Intervention to Reduce Use of Unproven or Ineffective Breast Cancer Care

Medical College of Wisconsin logo

Medical College of Wisconsin

Status

Completed

Conditions

Breast Cancer

Treatments

Behavioral: Control group - observational
Behavioral: Enhanced intervention
Behavioral: Basic public reporting

Study type

Interventional

Funder types

Other
NIH

Identifiers

NCT02831439
PRO00022912
R01CA190016 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The goal of this project is to examine the effectiveness and potential cost savings of two organizational interventions aimed at reducing the use of ineffective or unproven care among women with incident breast cancer.

Full description

Challenged by public opinion, peers and the Congressional Budget Office, a number of specialty societies have recently begun to develop "Top Five" lists of relatively expensive procedures that do not provide meaningful benefit to at least some categories of patients for whom they are commonly ordered. The Choosing Wisely® campaign is the most visible example. The extent to which the development of these lists has influenced the behavior of physicians or patients, however, remains unknown.

In this study, investigators partner with the Wisconsin Collaborative for Healthcare Quality (WCHQ), a statewide consortium of hospitals, medical practices and health systems, to examine the effectiveness of two organizational interventions in reducing unproven or ineffective breast cancer care. Two interventions will be tested: (a) A "basic" public reporting intervention which summarizes on a public website practice-level statistics regarding use of targeted ineffective or unproven interventions for breast cancer and (ii) an "enhanced" intervention, augmenting public reporting with a smart phone-based application (App) that gives providers just-in-time information, decision-making tools, and personalized patient education materials that support reductions in the use of breast cancer interventions targeted based upon Choosing Wisely® or national oncology society guidelines. Specifically, the aims are: (1) To examine whether basic public reporting reduces use of targeted breast cancer practices among a contemporary cohort of patients with incident breast cancer in the intervention state relative to usual care in comparison states, using Marketscan and Medicare claims data while adjusting for possible confounders and temporal trends; (2) To examine the effectiveness of the enhanced intervention relative to the basic intervention; and (3) To simulate cost savings forthcoming from nationwide implementation of both interventions (relative to each other and to usual care) and to describe the implications of these findings for reimbursement policy and program initiatives.

The results will provide rigorous evidence regarding the effectiveness of a unique all-payer, all-age public reporting system for influencing provider behavior that may be easily exportable to other states. Findings will be further relevant to the ACO environment, which is expected to provide financial disincentives for providing ineffective or unproven care.

Enrollment

400,415 patients

Sex

Female

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

I. Health care providers: Health care providers (regardless of age, gender or race/ethnicity) in participating WCHQ practices who will provide breast cancer care to about 9,000 women who had an incident breast cancer surgery between 2014-2017.

II. Patients: Medicare and Marketscan women who had an incident breast cancer surgery between 2014-2017. No exclusions will be made by age or race/ethnicity. The focus on women is dictated by the very low prevalence of breast cancer among men.

Identification of incident breast cancer surgery in these datasets will be done using a validated algorithm developed by Nattinger et al.

Exclusion criteria

  • Male patients are excluded from this analysis due to the low prevalence of breast cancer among males.

Trial design

Primary purpose

Health Services Research

Allocation

Non-Randomized

Interventional model

Single Group Assignment

Masking

None (Open label)

400,415 participants in 2 patient groups

Intervention
Experimental group
Description:
Participating health systems in Wisconsin. Interventions include: Basic public reporting and the enhanced intervention (app)
Treatment:
Behavioral: Basic public reporting
Behavioral: Enhanced intervention
Control
Other group
Description:
Health systems in comparison states. Control includes: Cost savings comparison
Treatment:
Behavioral: Control group - observational

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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