Effect of Norms on Laboratory and Imaging Testing (ENLITen) (ENLITen)

April 3, 2023 updated by: Kira Ryskina, University of Pennsylvania

The Effect of Norms on Laboratory and Imaging Testing (ENLITen): a Pragmatic Randomized Controlled Trial

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed 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.

Study Type

Interventional

Enrollment (Actual)

154

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Report card arm
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.
Behavioral: Normative report card
Personalized visual report card describing physician's laboratory ordering pattern for prior week relative to peers as well as a link to a website tracking lab ordering for the team in real time compared to peer teams.
No Intervention: Control arm
Physicians in the control arm will not receive the email or website link.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Routine laboratory tests/patient-day
Time Frame: 6 months
the number of routine laboratory tests per patient-day ordered by the physicians-in-training
6 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Laboratory costs
Time Frame: 6 months
6 months
Routine imaging tests/patient-day
Time Frame: 6 months
6 months
Physicians' attitudes toward laboratory test use and receiving feedback
Time Frame: 6 months
Focus groups
6 months

Other Outcome Measures

Outcome Measure
Time Frame
Non-routine laboratory tests/patient-day
Time Frame: 6 months
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Pennsylvania

Investigators

  • Principal Investigator: Kira L Ryskina, MD, University of Pennsylvania

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

December 1, 2015

Primary Completion (Actual)

June 1, 2016

Study Completion (Actual)

September 1, 2016

Study Registration Dates

First Submitted

December 29, 2014

First Submitted That Met QC Criteria

December 30, 2014

First Posted (Estimate)

January 1, 2015

Study Record Updates

Last Update Posted (Actual)

April 6, 2023

Last Update Submitted That Met QC Criteria

April 3, 2023

Last Verified

April 1, 2023

More Information

Terms related to this study

Other Study ID Numbers

  • 820924

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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