Emergency DepartmentIQEDNCT03966989
Improving Quality & Equity of Emergency Care Decisions (IQED)
A study testing Performance Feedback in people with Emergency Department, run by University of Southern California at 4 sites in United States.
Trial summary
Recent work in emergency medicine has shown errors were more likely to occur at the end of shifts, as pressure exists to make a number of decisions simultaneously, and after what may be an already long series of cognitive challenges. Decision fatigue may also contribute to disparities by surfacing subconscious bias. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Emergency Department
- What is being tested?
- Performance Feedback
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- 4 sitesUnited States
- Study dates
- Dec 2021to Jun 2022
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Attendings and residents that see patients in the Emergency Department.
Who cannot join
- None
Trial locations and contacts
4 sites in 1 country.
United States4 sites
Lac + Usc
Los Angeles, California, 90033
University of California, Davis
Sacramento, California, 95817
Olive View Medical Center
Sylmar, California, 91342
Harbor UCLA
Torrance, California, 90502
About this study
Official title: Improving Quality & Equity of Emergency Care Decisions (IQED): R21 Pilot Phase
Recent work in emergency medicine has shown errors were more likely to occur at the end of shifts, as pressure exists to make a number of decisions simultaneously, and after what may be an already long series of cognitive challenges. Decision fatigue may also contribute to disparities by surfacing subconscious bias. The objective of the R21 pilot phase of Improving Quality \& Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.
Read the detailed description
The objective of the R21 pilot phase of Improving Quality \& Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.
Each clinician will be randomized at the provider or clinic level to either the intervention or control group. Once clinicians are randomized, the aforementioned intervention will be turned on for a 3-6 month time period.
For providers in the intervention group, the goal is to evaluate the effect of social norms on overuse and underuse behavior related to prescriptions or testing. Near real-time social norms will be delivered to providers which benchmark their own performance on various metrics to that of their peers. The investigators performance feedback reports for each provider randomized to receive the audit and feedback intervention will have three key characteristics: (1) each target provider will receive his or her individual performance, (2) benchmarks will prominently feature the performance of providers who would be considered credible peers of the target provider, and (3) benchmarks will reflect only performance that is desirable (e.g., showing only the performance of the best-performing credible peers).
Providers randomized to the control group will follow standard practice.
- Conditions
- Emergency Department
- Being tested
- Performance Feedback
- Keywords
- Emergency Medicine, Behavioral Research
- Medical subject headings
- Emergencies
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Performance FeedbackBehavioural
Performance feedback offline that benchmarks providers' own performance to that of their peers
| Study group | Role | What they receive |
|---|---|---|
| Performance Feedback | Experimental | Feedback offline either via email or text Receives: Behavioral: Performance Feedback |
| Control | No intervention | Standard practice control |
What is being measured
The primary outcome is the main question the study is designed to answer.
Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Chest Pain
Measurement of clinician adherence to guidelines for quality measures related to chest pain (proportion of cases in which HEART score algorithm was used for chest pain patients)
Measured: 6 months
Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: CT imaging
Measurement of clinician adherence to guidelines for quality measures related to CT imaging (proportion of orders for unnecessary CT scans)
Measured: 6 months
Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Antibiotic prescribing
Measurement of clinician adherence to guidelines for quality measures related to antibiotic prescribing (proportion of inappropriate antibiotic prescriptions for acute respiratory infections)
Measured: 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 May 2019
- Study startDec 2021 (estimated)
- Primary completionJun 2022 (estimated)
- Study completionJun 2022 (estimated)
Why it stopped: Withdrawn due to COVID-19 pandemic
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Emergency DepartmentStudies of the same condition, open and under way.
- More trials run by University of Southern CaliforniaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Southern California
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute on Aging (NIA), University of California, Los Angeles, Olive View-UCLA Education & Research Institute, LAC+USC Medical Center, University of California, Davis
- Responsible party
- Principal investigator, Daniella Meeker, University of Southern California
- Investigators
- Daniella Meeker, Principal investigator, University of Southern California
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03966989
- Sponsor's protocol ID
- HS-18-00522
- Other IDs
- R21AG057400
- Acronym
- IQED
- Status last verified
- Dec 2021
- First submitted
- 14 May 2019
- Last updated
- 20 Dec 2021
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 20 Dec 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Improving Quality & Equity of Emergency Care Decisions (IQED): R21 Pilot Phase
- ClinicalTrials.gov ID
- NCT03966989
- Acronym / sponsor ID
- IQED / HS-18-00522
- Conditions
- Emergency Department
- Keywords
- Emergency Medicine, Behavioral Research
- Study type
- Interventional
- Recruitment status
- WithdrawnReason stopped: Withdrawn due to COVID-19 pandemic
- Enrolment
- 0 participants (actual)
- Lead sponsor
- University of Southern CaliforniaUniversity, hospital or other
- Collaborators
- National Institute on Aging (NIA), University of California, Los Angeles, Olive View-UCLA Education & Research Institute, LAC+USC Medical Center, University of California, Davis
- Study start
- Dec 2021 (estimated)
- Primary completion
- Jun 2022 (estimated)
- Study completion
- Jun 2022 (estimated)
- First posted
- 29 May 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Recent work in emergency medicine has shown errors were more likely to occur at the end of shifts, as pressure exists to make a number of decisions simultaneously, and after what may be an already long series of cognitive challenges. Decision fatigue may also contribute to disparities by surfacing subconscious bias. The objective of the R21 pilot phase of Improving Quality \& Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.
Detailed description
The objective of the R21 pilot phase of Improving Quality \& Equity of Emergency Care Decisions (IQED) is to identify addressable gaps in quality and equity and use performance feedback as an intervention to improve performance on chest pain, CT imaging, and antibiotic prescribing. Performance feedback intervention will include feedback offline via email or text.
Each clinician will be randomized at the provider or clinic level to either the intervention or control group. Once clinicians are randomized, the aforementioned intervention will be turned on for a 3-6 month time period.
For providers in the intervention group, the goal is to evaluate the effect of social norms on overuse and underuse behavior related to prescriptions or testing. Near real-time social norms will be delivered to providers which benchmark their own performance on various metrics to that of their peers. The investigators performance feedback reports for each provider randomized to receive the audit and feedback intervention will have three key characteristics: (1) each target provider will receive his or her individual performance, (2) benchmarks will prominently feature the performance of providers who would be considered credible peers of the target provider, and (3) benchmarks will reflect only performance that is desirable (e.g., showing only the performance of the best-performing credible peers).
Providers randomized to the control group will follow standard practice.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Performance Feedback | Experimental | Behavioral: Performance FeedbackFeedback offline either via email or text |
| Control | No intervention | –Standard practice control |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Attendings and residents that see patients in the Emergency Department.
Key exclusion criteria (1 listed)
- None
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Performance FeedbackPerformance feedback offline that benchmarks providers' own performance to that of their peers | Behavioural | Performance Feedback |
Primary outcome
Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Chest Pain
Time frame: 6 months
Measurement of clinician adherence to guidelines for quality measures related to chest pain (proportion of cases in which HEART score algorithm was used for chest pain patients)
Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: CT imaging
Time frame: 6 months
Measurement of clinician adherence to guidelines for quality measures related to CT imaging (proportion of orders for unnecessary CT scans)
Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Antibiotic prescribing
Time frame: 6 months
Measurement of clinician adherence to guidelines for quality measures related to antibiotic prescribing (proportion of inappropriate antibiotic prescriptions for acute respiratory infections)
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Dec 2021.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Daniella Meeker principal investigator
University of Southern California
4 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Performance Feedback in people with Emergency Department, run by University of Southern California at 4 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: withdrawn, as of the sponsor's last update on 20 Dec 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study was withdrawn before enrolling participants, so there are no results.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Efficacy of behavioral nudges to improve quality and safety in Emergency Medicine through measurement of adherence to guidelines: Chest Pain (time frame: 6 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Dec 2021.