Precommitting to choose wisely about low-value services: a stepped wedge cluster randomised trial
| العنوان: | Precommitting to choose wisely about low-value services: a stepped wedge cluster randomised trial |
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| المؤلفون: | Yubraj Acharya, Jeffrey T. Kullgren, Ariel Linden, James Alford, Jacquelyn Miller, Richard Duffy, Abigail A. Schachter, Julia Adler-Milstein, Erin L. Krupka |
| المصدر: | BMJ Quality & Safety. 27:355-364 |
| بيانات النشر: | BMJ, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | medicine.medical_specialty, business.industry, Health Policy, Health services research, Disease cluster, Low back pain, 03 medical and health sciences, 0302 clinical medicine, Ambulatory care, Intervention (counseling), Physical therapy, medicine, Stepped wedge, 030212 general & internal medicine, Headaches, medicine.symptom, business, 030217 neurology & neurosurgery, Patient education |
| الوصف: | BackgroundLittle is known about how to discourage clinicians from ordering low-value services. Our objective was to test whether clinicians committing their future selves (ie, precommitting) to follow Choosing Wisely recommendations with decision supports could decrease potentially low-value orders.MethodsWe conducted a 12-month stepped wedge cluster randomised trial among 45 primary care physicians and advanced practice providers in six adult primary care clinics of a US community group practice.Clinicians were invited to precommit to Choosing Wisely recommendations against imaging for uncomplicated low back pain, imaging for uncomplicated headaches and unnecessary antibiotics for acute sinusitis. Clinicians who precommitted received 1–6 months of point-of-care precommitment reminders as well as patient education handouts and weekly emails with resources to support communication about low-value services.The primary outcome was the difference between control and intervention period percentages of visits with potentially low-value orders. Secondary outcomes were differences between control and intervention period percentages of visits with possible alternate orders, and differences between control and 3-month postintervention follow-up period percentages of visits with potentially low-value orders.ResultsThe intervention was not associated with a change in the percentage of visits with potentially low-value orders overall, for headaches or for acute sinusitis, but was associated with a 1.7% overall increase in alternate orders (p=0.01). For low back pain, the intervention was associated with a 1.2% decrease in the percentage of visits with potentially low-value orders (p=0.001) and a 1.9% increase in the percentage of visits with alternate orders (p=0.007). No changes were sustained in follow-up.ConclusionClinician precommitment to follow Choosing Wisely recommendations was associated with a small, unsustained decrease in potentially low-value orders for only one of three targeted conditions and may have increased alternate orders.Trial registration numberNCT02247050; Pre-results. |
| تدمد: | 2044-5423 2044-5415 |
| DOI: | 10.1136/bmjqs-2017-006699 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::a38eadc334f5fa913c58685feebf1253 https://doi.org/10.1136/bmjqs-2017-006699 |
| رقم الانضمام: | edsair.doi...........a38eadc334f5fa913c58685feebf1253 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20445423 20445415 |
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| DOI: | 10.1136/bmjqs-2017-006699 |