Evaluating a Our Practice Advisory (OPA) to Optimize Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) Test Orders

University of California, Los Angeles (UCLA)

Status: Enrolling

Conditions: Physician Workflow; Resource Utilization

Treatments: Behavioral: OPA

Study type: Interventional

Funder types: Other

Identifiers

NCT06993805

IRB-25-0120

Details and patient eligibility

About

Our Practice Advisory (OPA) are essential tools in clinical decision-making. The alerts are designed to guide providers towards evidence-based practices and improve patient outcomes. The focus of this initiative is on Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) testing, with the goal of addressing unnecessary repeat testing within a 30-day timeframe, which rarely yields significant new insights. Although randomization occurs at the patient level, the primary outcome of this study focuses on provider behavior and decision-making.

By focusing on this specific intervention, the study aims to optimize resource use, align test ordering with evidence-based guidelines, and support improved patient outcomes. The results of this evaluation will help refine OPAs and guide broader strategies for implementing clinical decision support tools across healthcare systems.

Full description

The purpose of this Quality Improvement (QI) initiative is to evaluate the impact of a randomized Our Practice Advisory (OPA) intervention on physician ordering behavior of Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) tests within a 30-day interval from the prior test. The OPA will fire when an A1c or TSH are ordered within 30 days of a prior result (these short-interval tests are widely considered unnecessary) and will ask providers to reconsider the order. This study will evaluate the effectiveness of this intervention by randomizing patients 1:1 such that physicians caring for the patient will either (1) receive the OPA or (2) not receive the OPA if the providers order a short-interval test. This study is being conducted for a primary QI intent, as the results will (1) dictate if the short-interval OPA should be implemented across all patients, and (2) if this short-interval OPA should be applied to other labs aside from A1c and TSH. In these ways, the purpose of this study is to directly inform health system operations.

Enrollment: 384 estimated patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 years or older
• Inpatient or observation stays within UCLA Health System hospitals
• Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) ordered, AND this lab was ordered and resulted within the prior 30 days

Exclusion criteria

• Have an A1c or TSH ordered and do not have a result for one of these labs in the prior 30 days

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

---

384 participants in 2 patient groups

OPA Intervention Group

Experimental group

Description:

Providers in this group will receive a Our Practice Advisory (OPA) through the electronic health record (EHR) system when ordering Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) tests. The OPA will prompt providers to reconsider the test if it was ordered within the previous 30 days, aligning with evidence-based guidelines to reduce unnecessary testing.

Treatment:

Behavioral: OPA

Control Group

No Intervention group

Description:

Providers in this group will not receive a Our Practice Advisory (OPA) through the Electronic Health Record (EHR) system when ordering Hemoglobin A1c (A1c) and Thyroid-Stimulating Hormone (TSH) tests. This group represents the current standard of care, with no additional prompts or alerts implemented.