- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05413070
Quality Improvement re: Choosing Wisely Back Pain Measures (SCV LBP)
Improving Performance on Choosing Wisely Low Back Pain Measures in Primary Care: Learning From Within
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Two common low-value services are related to acute low back pain. Choosing Wisely advises avoiding the use of imaging during the first 6 weeks of low back pain (per the American Academy of Family Physicians and other organizations). Similarly, Choosing Wisely advises avoiding opioids in the treatment of low back pain until other alternatives have been attempted (per the North American Spine Society). Together, overutilization of these two services (imaging and opioids for low back pain) costs more than $500 annually, not including downstream costs, and is a source of patient harm. In the state of Virginia, the Virginia Center for Health Innovation has identified the two back pain measures as priority for reducing as part of their 3-year intervention (Smarter Care Virginia): https://www.vahealthinnovation.org/scv/
As a participant in Smarter Care Virginia (SCV), Carilion receives data showing each Carilion Clinic clinician's performance on SCV measures, including the two back pain measures. For example, Carilion receives a database that lists the clinician's name, department, number of appropriate orders for each SCV measure made and the number of low-value orders for each SCV measure made. Carilion (and the other 7 participating health systems) are asked to use this information to generate quality improvement initiatives. We have designed a quality improvement initiative focused on family and community medicine clinicians and the two back pain measures.
First, we will use the most recent data provided by the SCV project (2020 and Q1-Q2 of 2021) to rank FCM practices and clinicians by utilization of low-value back pain services, their waste index, and impact score. We will identify from this ranking the top 5 to 10 performing practices and the bottom 5 to 10 performing practices. If there are any outlier clinicians who are bottom performing (ie: provide the most low-value services or have the highest impact score) but who do not fall among the bottom performing practices, we will consider including their practice among the bottom 5 to 10.
We will survey clinicians in top and bottom performing practices to learn more about their knowledge, perceptions, and practice workflow related to the two back pain measures. They will also be asked about their trust in data measures. No identifying information will be collected from clinicians in the survey.
From what we learn from survey data, we will design up to four brief education points to be communicated during regular practice quality improvement meetings with population health managers.
Prior to the delivery of quality improvement education about back pain measures, we will obtain an EMR report for the top and bottom performing practices showing utilization rate of both back pain measures. We will also conduct a chart review (Epic) to identify indication for provision of the back pain services that could not be detected in claims data or Epic data. This addresses a common concern of clinicians - that clinical nuance is not being detected and low value care is being over-assigned. The Epic reports and chart reviews will continue monthly for the first 3 months and then at months 6 and 12.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Locations
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Virginia
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Roanoke, Virginia, United States, 24016
- Carilion Clinic Dept of Family and Community Medicine
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
Current primary care clinician in a top or bottom performing practice
Exclusion Criteria:
<90 days of tenure in current position
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Lowest Performing Practices
This is the group of 5 to 10 primary care practices that incurred the highest amount of low-value back pain imaging based on claims data reports.
This group will receive the survey and the intervention (brief training sessions in existing quality improvement meetings, performance reports, etc.).
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Up to 4 brief educational components in existing quality meetings Informational email/newsletter Individualized performance feedback reports Educational resources for patients
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Highest Performing Practices
This is the group of 5 primary care practices that incurred the lowest amount of low-value back pain imaging based on claims data reports.
This group will only receive the survey.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Knowledge, perceptions, decision-making related to back pain imaging
Time Frame: June-August 2022
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Survey responses
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June-August 2022
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Rate of low-value back pain imaging
Time Frame: June-August 2022
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Derived from APC data, via Milliman Health Waste Calculator
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June-August 2022
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Rate of low-value back pain imaging
Time Frame: August 2022-December 2023
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Derived from EMR measures (live)
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August 2022-December 2023
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Clinical documentation comparison
Time Frame: August 2022-December 2023
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Comparison of EMR chart review reason for ordering imaging vs. EMR-derived measure
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August 2022-December 2023
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Collaborators and Investigators
Sponsor
Collaborators
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB-22-1568
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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