Effect of Norms on Laboratory and Imaging Testing (ENLITen)

University of Pennsylvania

Status: Completed

Conditions: Utilization; Laboratory, Hospital

Treatments: Behavioral: Normative report card

Study type: Interventional

Funder types: Other

Identifiers

NCT02330289

820924

Details and patient eligibility

About

Studies suggest that some laboratory tests ordered for hospitalized patients are duplicative or have limited value. This study will evaluate a normative feedback intervention to reduce overuse of laboratory tests for hospitalized patients by internal medicine physicians-in-training.

Full description

Past research has shown that 25% of diagnostic testing is duplicative or has limited value. Academic medical centers that employ physicians-in-training may find it particularly challenging to reduce low value testing due to a historical emphasis on extensive workups by trainees. Despite the increased emphasis on cost-consciousness in medical education, there is little existing research evaluating ways to optimize ordering behaviors of physicians-in-training. This study will evaluate a normative feedback intervention for internal medicine physicians-in-training to reduce overuse of routine laboratory tests for hospitalized patients. Physicians-in-training will be cluster-randomized into two arms: (1) those who receive report cards (intervention group), (2) those who will not receive report cards (control group). We will study the use of routine laboratory tests over a pre-intervention period of 1 week and a post-randomization period of 1 week. We will study physician attitudes about the real-time feedback dashboard with qualitative assessments in focus groups after the completion of the intervention.

Enrollment: 154 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Any internal medicine physician-in-training scheduled to rotate through general medicine services at HUP during the study period will be included in the study.

Exclusion criteria

• Physicians-in-training pulled for weekend coverage or sick coverage will be excluded. Medical students will be excluded.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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154 participants in 2 patient groups

Report card arm

Experimental group

Description:

The intervention arm will receive an email report card describing their lab use compared to their peers as well as a link to a website visually tracking the team's daily ordering of common lab tests compared to the peer teams.

Treatment:

Behavioral: Normative report card

Control arm

No Intervention group

Description:

Physicians in the control arm will not receive the email or website link.