Provider Alerts to Reduce Unnecessary Care

10 Clinics within Stanford Health Care are randomized to receive or not receive provider alerts for 5 commonly overused tests and treatments.

Study Overview

• Status: Completed
• Conditions: Physician's Role
• Intervention / Treatment: Behavioral: Electronic Record Alert

Detailed Description

10 Clinics within Stanford Health Care are randomized to receive or not receive provider alerts for 5 commonly overused tests and treatments.

Thus there will potentially be 50 clinics enrolled across the 5 tests/treatment categories. However, it is expected that some clinics will meet criteria to be one of the 10 clinics in more than test/treatment category. Thus the total number of clinics involved will be between 10 and 50.

These 5 tests / treatments are taken from the Choosing Wisely list. All alerts will be provided using the electronic medical record and will be automated.

• Study Type: Interventional
• Enrollment (Actual): 50
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

High volume clinics defined as the top 10 clinics in Stanford Health Care based on number of electronic orders.

Exclusion Criteria:

None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Provider Alert; This arm is the intervention arm. This arm will receive the Electronic Record Alert.	Behavioral: Electronic Record Alert; Electronic alert within the medical record indicating the ordered test or treatment may be inappropriate. The provider can indicate why the test or treatment is appropriate and complete the order.
No Intervention: No Provider Alert; This arm is the control arm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of electronic orders entered per 100 clinic patients.	There are five primary outcomes for the five different alerts. For each alert study the outcome will be orders that would qualify for an alert per 100 patients.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of potential electronic alerts divided by the number of electronic orders	There will be five secondary outcomes which will be the alert candidate to order ratio. For both the control and intervention groups we will determine the fraction of orders that qualify for an alert.	6 months

Collaborators and Investigators

• Sponsor: Stanford University

Publications and helpful links

General Publications

• Ho VT, Aikens RC, Tso G, Heidenreich PA, Sharp C, Asch SM, Chen JH, Shah NK. Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial. J Am Med Inform Assoc. 2022 Oct 7;29(11):1941-1948. doi: 10.1093/jamia/ocac139.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2016
• Primary Completion (Actual): February 1, 2018
• Study Completion (Actual): July 1, 2018

Study Registration Dates

• First Submitted: March 2, 2016
• First Submitted That Met QC Criteria: March 11, 2016
• First Posted (Estimate): March 16, 2016

Study Record Updates

• Last Update Posted (Actual): June 14, 2021
• Last Update Submitted That Met QC Criteria: June 10, 2021
• Last Verified: June 1, 2021

More Information

Terms related to this study

• Other Study ID Numbers: SHCQICW1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO