Improving Engagement With a Process Measure Dashboard Through Precision Feedback

The study seeks to assess the impact of e-mailing specific, targeted, practice-pattern based information ("precision feedback") on provider engagement with a dashboard for a quality process measure (showing stent omission after pre-stented ureteroscopy), compared with generic information ("one size fits most" feedback).

Study Overview

• Status: Completed
• Conditions: Behavior
• Intervention / Treatment: Behavioral: Dashboard; Behavioral: Precision Feedback Push

Detailed Description

The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a state-wide, physician-led quality improvement collaborative comprised of over 40 urology practices representing varied practice sites within Michigan and nationally, designed to evaluate and improve the quality of urologic care.

A recently identified area for quality improvement within MUSIC is avoidance of placing ureteral stents following uncomplicated ureteroscopy and lithotripsy for kidney stones. Such unnecessary stents do not measurably increase post-operative safety, but rather have been shown to contribute to unnecessary emergency department visits. This process measure (stent omission after uncomplicated ureteroscopy) is the subject matter for the dashboard and will serve as the focus of precision feedback.

The study team hypothesizes that a behavior change intervention bundle consisting of "precision feedback" along with communication strategies to simplify access to feedback will increase dashboard engagement (measured via click-through rate and dashboard logins) compared with standard "one size fits most" e-mail messages. Knowledge gained from this study will inform the development of other precision feedback programs within our urology quality improvement collaborative (MUSIC), and provide a framework for rapid, pragmatic trials for small to mid-sized collaborative quality initiatives nationally.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • University of Michigan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

-Urologists participating in MUSIC that were in the top one hundred individuals in annual case volume from 2023 for "pre-stented ureteroscopy", the case for which the dashboard contents are most relevant.

Exclusion Criteria:

- Urologists that are not in the top one hundred individuals in annual "pre-stented ureteroscopy" case volume, urologists in the study team, or that opt out from the study at the individual or site level.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group 1 dashboard (3 months) then dashboard with Precision feedback (12 months); Months 0-3 dashboard only, months 3-15 months dashboard with Precision feedback.	Behavioral: Dashboard; The Dashboard intervention, representing current standard of care, will consist of a standard e-mail message with a link to the dashboard and text explanation. No performance data will be included in the e-mail, and links will not be monitored for clickthrough with repeat e-mail.; Behavioral: Precision Feedback Push; The experimental intervention, precision feedback e-mail messaging, will consist of an e-mail with a link to the dashboard along with tailored information about a participant's performance in the quality process measure of interest. For example, e-mail subject lines may read "You have room for improvement in stent omission," accompanied by a visual display in the body of the e-mail showing a participant's performance relative to a top performing peer. The behavior change intervention delivery component will also involve modifications to existing procedures. Namely, performance feedback will be reported directly in the e-mail as either plain text, or an embedded or attached image with graphed data.
Experimental: Group 2 dashboard (6 months) then dashboard with Precision feedback (6 months); Months 0-6 dashboard only, months 6-15 months dashboard with Precision feedback.	Behavioral: Dashboard; The Dashboard intervention, representing current standard of care, will consist of a standard e-mail message with a link to the dashboard and text explanation. No performance data will be included in the e-mail, and links will not be monitored for clickthrough with repeat e-mail.; Behavioral: Precision Feedback Push; The experimental intervention, precision feedback e-mail messaging, will consist of an e-mail with a link to the dashboard along with tailored information about a participant's performance in the quality process measure of interest. For example, e-mail subject lines may read "You have room for improvement in stent omission," accompanied by a visual display in the body of the e-mail showing a participant's performance relative to a top performing peer. The behavior change intervention delivery component will also involve modifications to existing procedures. Namely, performance feedback will be reported directly in the e-mail as either plain text, or an embedded or attached image with graphed data.
Experimental: Group 3 dashboard (9 months) then dashboard with Precision feedback (6 months); Months 0-9 dashboard only, months 9-15 months dashboard with Precision feedback.	Behavioral: Dashboard; The Dashboard intervention, representing current standard of care, will consist of a standard e-mail message with a link to the dashboard and text explanation. No performance data will be included in the e-mail, and links will not be monitored for clickthrough with repeat e-mail.; Behavioral: Precision Feedback Push; The experimental intervention, precision feedback e-mail messaging, will consist of an e-mail with a link to the dashboard along with tailored information about a participant's performance in the quality process measure of interest. For example, e-mail subject lines may read "You have room for improvement in stent omission," accompanied by a visual display in the body of the e-mail showing a participant's performance relative to a top performing peer. The behavior change intervention delivery component will also involve modifications to existing procedures. Namely, performance feedback will be reported directly in the e-mail as either plain text, or an embedded or attached image with graphed data.
Experimental: Group 4 dashboard (12 months) then dashboard with Precision feedback (3 months); Months 0-12 dashboard only, months 12-15 months dashboard with Precision feedback.	Behavioral: Dashboard; The Dashboard intervention, representing current standard of care, will consist of a standard e-mail message with a link to the dashboard and text explanation. No performance data will be included in the e-mail, and links will not be monitored for clickthrough with repeat e-mail.; Behavioral: Precision Feedback Push; The experimental intervention, precision feedback e-mail messaging, will consist of an e-mail with a link to the dashboard along with tailored information about a participant's performance in the quality process measure of interest. For example, e-mail subject lines may read "You have room for improvement in stent omission," accompanied by a visual display in the body of the e-mail showing a participant's performance relative to a top performing peer. The behavior change intervention delivery component will also involve modifications to existing procedures. Namely, performance feedback will be reported directly in the e-mail as either plain text, or an embedded or attached image with graphed data.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clickthrough rate to the online dashboard	Clickthrough is defined as a link ever being clicked in the three months following e-mail send date, at which point in time a new e-mail will be sent. Clickthrough rate will be calculated as the number of clickthroughs divided by number of links sent (i.e., opportunities for clickthrough).	Every 3 months up to 15 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total number of dashboard visits	Dashboard visits captured by Google Analytics.	15 months
Cumulative time (minutes) spent on the dashboard	Time spent will be captured by Google Analytics.	15 months
Urologist opt-out rate		15 months
Helpful/not helpful rate	There will be one question if the intervention was helpful or not.	15 months
Stent rate for pre-stented ureteroscopy		15 months
E-mail open rate	E-mail open rate will be measured as number of e-mail opens divided by number of e-mails sent.	Every 3 months up to 15 months

Collaborators and Investigators

• Sponsor: University of Michigan
• Investigators: Principal Investigator: Kristian Stensland, MD, University of Michigan

Publications and helpful links

General Publications

• Lewicki P, Clark S, Shoemaker E, Wang B, Ross J, Daignault-Newton S, Carlozzi N, Martin-Schwarze A, Meurer W, Sales A, Ghani K, Dauw C, Stensland K. Rationale and protocol for a prospective clinical trial enrollment improvement hybrid study within a trial. Contemp Clin Trials Commun. 2025 Sep 20;48:101548. doi: 10.1016/j.conctc.2025.101548. eCollection 2025 Dec.
• Lewicki P, Salka B, Daignault-Newton S, Ross J, Krumm A, Ghani KR, Dauw C, Landis-Lewis Z, Stensland KD; Michigan Urological Surgery Improvement Collaborative. Rapid cycle, randomised testing of precision feedback to improve engagement with a process measure dashboard amongst urologists: study protocol for a hybrid trial. BMJ Open. 2025 May 6;15(5):e092742. doi: 10.1136/bmjopen-2024-092742.

Study record dates

Study Major Dates

• Study Start (Actual): July 17, 2024
• Primary Completion (Actual): October 31, 2025
• Study Completion (Actual): October 31, 2025

Study Registration Dates

• First Submitted: June 13, 2024
• First Submitted That Met QC Criteria: June 13, 2024
• First Posted (Actual): June 20, 2024

Study Record Updates

• Last Update Posted (Estimated): January 12, 2026
• Last Update Submitted That Met QC Criteria: January 8, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Behavior change; Ureteral stent omission; Ureteral stent placement; Dashboard; Precision feedback
• Additional Relevant MeSH Terms: Behavior; Organization and Administration; Health Services Administration; Management Information Systems; Database Management Systems; Dashboard Systems
• Other Study ID Numbers: HUM00248876

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No