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Nudging Healthcare Organizations to Adopt New Care Delivery Practices

24. juni 2020 opdateret af: Amber Barnato, Dartmouth-Hitchcock Medical Center

Accelerating the Use of Evidence-based Innovation in Health Care Systems

This two-arm, parallel group randomized controlled trial will assess the impact of written social norms messaging (i.e., behavioral 'nudges') on healthcare organization administrators' decision to access online resources that support the adoption of evidence-based healthcare delivery practices. The healthcare delivery practices include the use of population screening tools, clinical practice guidelines, and shared decision making training.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

The purpose of this study is to assess if behavioral 'nudges' impact the likelihood of healthcare organization administrators accessing technical assistance resources to support uptake of care delivery practices that: (1) have the potential to improve patient outcomes; and (2) have already been adopted by most healthcare organizations. A 'nudge' is a change in the way information is presented that attempts to steer people in a certain direction but does not restrict their choices.

The investigator will conduct a randomized controlled trial of written messages to healthcare administrators at three types of healthcare organizations - physician practices, hospitals and healthcare systems - from among 3,402 administrators who completed Dartmouth's National Survey of Healthcare Organizations and Systems (NSHOS) in 2017-2018.

In Fall 2019 the investigator will mail a customized report to all NSHOS respondents that compares their organizations' survey responses to their peer organizations. The investigator will randomize the 2,387 respondents whose organizations have not implemented one or more of up to seven chosen care delivery practices to cover letters with or without social norms messaging. The written messaging in the 'control condition' cover letter lists the practices for which the NSHOS team has prepared technical assistance materials in support of practice adoption, and contains a link to these online resources. The 'intervention condition' additionally highlights the organization's performance compared to its peers in adopting the practices using visual data display and explicit social norms messaging.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

2387

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • New Hampshire
      • Lebanon, New Hampshire, Forenede Stater, 03766
        • Dartmouth Hitchcock Medical Center

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Participant responded to NSHOS survey and reported that their organization had not implemented at least one of up to seven pre-determined care delivery practices, out of the following eight practices featured in the NSHOS: Screening for opioid use specifically; Screening for substance use disorders; Screening for depression; Screening for interpersonal violence; Method for identifying high-cost patients; Use of evidence-based guidelines for congestive heart failure; Use of evidence-based guidelines for sepsis (included in letters to healthcare system administrators, but not hospitals or physician practices); Training for shared decision making (included in letters to hospitals and physician practices but not healthcare systems)

Exclusion Criteria:

  • Did not respond to NSHOS survey
  • Participant responded to NSHOS survey and reported that their organization had already implemented each of seven pre-determined care delivery practices, out of the following eight practices featured in the NSHOS: Screening for opioid use specifically; Screening for substance use disorders; Screening for depression; Screening for interpersonal violence; Method for identifying high-cost patients; Use of evidence-based guidelines for congestive heart failure; Use of evidence-based guidelines for sepsis (included in letters to healthcare system administrators, but not hospitals or physician practices); Training for shared decision making (included in letters to hospitals and physician practices but not healthcare systems)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Sundhedstjenesteforskning
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Nudge Letter
Participants receive a letter that highlights their performance vs. peer organizations on up to seven care delivery practices featured in the National Survey of Healthcare Organizations and Systems (NSHOS). The letter includes a link to access technical assistance resources and is sent alongside the participant's NSHOS respondent report.
Adfærdsmæssigt: Peer comparison and social norms messaging
This group will receive a letter noting that their organization has not implemented at least one common care delivery practice that a majority their peers have already implemented. The letter will also note the percentage of peer organizations that have implemented the practice. This is done using peer comparison data and social norms messaging.
Ingen indgriben: Control Letter
Participants receive a letter with a link to technical assistance resources; the letter is sent alongside the participant's NSHOS survey respondent report.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Percentage of participants who access the technical assistance resource webpage
Tidsramme: Up to 2 months after letter is sent
The percentage of participants who access the technical assistance webpage will be determined by email and webpage analytics. The primary analysis will be intention to treat (i.e., among all participants sent a letter); a secondary analysis will be a 'per protocol' analysis (i.e., among all participants whose letter was not sent back as undeliverable). Exploratory sub-group analyses will be conducted by each strata characteristic (e.g., whether organization category influences the likelihood of accessing the webpage).
Up to 2 months after letter is sent

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Number of unique resource views on technical assistance resource webpage
Tidsramme: Up to 2 months after letter is sent
The number of unique resources viewed from the webpage, as determined by website analytics.
Up to 2 months after letter is sent
Percentage of participants who request connection to peer organizations via the technical assistance resource webpage
Tidsramme: Up to 2 months after letter is sent
The number of unique organizations that request to be matched with other healthcare organizations that have successfully implemented one of the care delivery practices, in order to learn from their experiences (there will be a clickable link on the webpage for organizations to request this connection). This will be determined by website analytics.
Up to 2 months after letter is sent
Perceived effect of letter on administrators' intentions
Tidsramme: Up to 4 months after letter is sent
Effect of letter on administrators' intentions and actions, measured by qualitative interviews in a sub-sample of participants.
Up to 4 months after letter is sent

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Dartmouth-Hitchcock Medical Center

Samarbejdspartnere

Agency for Healthcare Research and Quality (AHRQ)

Efterforskere

  • Ledende efterforsker: Amber E Barnato, MD, MPH, MS, Dartmouth College

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

9. december 2019

Primær færdiggørelse (Faktiske)

9. februar 2020

Studieafslutning (Faktiske)

8. juni 2020

Datoer for studieregistrering

Først indsendt

14. november 2019

Først indsendt, der opfyldte QC-kriterier

22. november 2019

Først opslået (Faktiske)

25. november 2019

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

26. juni 2020

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

24. juni 2020

Sidst verificeret

1. juni 2020

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • Dartmouth IRB protocol #28763
  • 1U19HS024075 (U.S.A. AHRQ bevilling/kontrakt)

Plan for individuelle deltagerdata (IPD)

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Kliniske forsøg med Levering af sundhedspleje

Kliniske forsøg med Peer comparison and social norms messaging

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Sponsorer og samarbejdspartnere

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Betingelser

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