Effects of Provider Commitments to Choose Wisely

Completed · Not applicable

Conditions studied: Health Services Misuse, Physician's Practice Patterns, Guideline Adherence, Unnecessary Procedures, Health Care Costs

In brief

Clinicians' decisions to order potentially unnecessary services -- such as those targeted in the Choosing Wisely® campaign -- are often affected by their high-pressure practice environments, which can make it hard to consistently avoid ordering low-value care. The field of behavioral economics offers a promising and highly scalable approach to decreasing use of low-value services: asking clinicians to commit to avoid ordering such services and providing them and their patients with resources to support adherence to this commitment. This project will evaluate the effects of such an intervention across 2 large health systems, Michigan Medicine and IHA, through a mixed-methods, stepped wedge cluster randomized trial. In each of the study clinics, clinicians will be invited to commit to following a set of targeted Choosing Wisely® recommendations. Clinicians who make such a commitment, and their patients, will receive access to key resources to support adherence to this commitment. To measure the effects of the intervention, automated clinical data and medical record data before and after the intervention will be examined. Surveys and semi-structured interviews of both clinicians and patients will also be conducted to determine the effects of the intervention on their decision-making and experiences.

Key facts

Study ID

NCT03411525

Run by

University of Michigan

People needed

489

Starts

2018-01-26

Expected to finish

2019-02-28

Last updated by the study team

2019-03-07

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: accepted.

You may qualify if…

• Clinician participants will be drawn from the pool of physicians, nurse practitioners, and physician assistants staffing the 8 primary care clinics.
• Patients of all 8 study clinics must meet criteria for one of the three Choosing Wisely® recommendations to be eligible to participate:
• 65 and older with type 2 diabetes
• 65 and older with insomnia and/or anxiety
• male, 75 and older with no history of prostate cancer.

You may not qualify if…

• Patients who have cognitive impairment and/or a serious psychiatric diagnosis will not be eligible to participate in the surveys or interviews.

Where it is running

• IHA Family & Internal Medicine - West Arbor — Ann Arbor, Michigan, United States
• IHA Internal Medicine - Domino's Farms — Ann Arbor, Michigan, United States
• Michigan Medicine Briarwood Medical Group — Ann Arbor, Michigan, United States
• Michigan Medicine East Ann Arbor Health and Geriatrics Center — Ann Arbor, Michigan, United States
• University of Michigan Medical School — Ann Arbor, Michigan, United States
• Michigan Medicine Brighton Health Center — Brighton, Michigan, United States
• IHA Family & Internal Medicine - Cherry Hill — Canton, Michigan, United States
• Michigan Medicine Canton Health Center — Canton, Michigan, United States
• IHA Internal Medicine - Towsley — Ypsilanti, Michigan, United States

Full record on ClinicalTrials.gov

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