Quality of Health Care
Conditions
Brief summary
Using behavioral economics, the study objective is to increase the efficiency, quality, and timeliness of care for Los Angeles County (LAC) Department of Health Services (DHS) patients by nudging specialists toward more effective use of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care.
Detailed description
Historically, the Los Angeles County (LAC) Department of Health Services (DHS) Safety Net system has faced challenges in delivering specialty services that are timely, geographically equitable, and coordinated in a patient centered manner. Recently, LACDHS improved infrastructure through implementation of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care. The study investigators will conduct a pragmatic randomized trial with the goal of increasing the efficiency, quality, and timeliness of care for LACDHS patients by nudging specialists toward more effective use of eConsult. If successful, these nudges may reduce the number and increase the value of face-to-face consults.
Interventions
BEHAVIORALRating tool
eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)
BEHAVIORALFeedback
eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange)
Sponsors
Los Angeles County Department of Public Health
University of Southern California
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* LACDHS providers who are eConsult system users
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rating - Medical Decision Making | Baseline to Post-Intervention, up to 12 months | Peers' ratings of Medical Decision Making in Specialists' responses to PCPs |
| Rating - Application of Expected Practices | Baseline to Post-Intervention, up to 12 months | Peers' ratings of Expected Practices in Specialists' responses to PCPs |
| Rating - Relationship Building | Baseline to Post-Intervention, up to 12 months | Peers' ratings Relationship Building in Specialists' responses to PCPs |
| Rating - Expert Elicitation | Baseline to Post-Intervention, up to 12 months | Peers' ratings of Specialists' skill in elicitation of information from PCPs |
| Rating - Educational Value | Baseline to Post-Intervention, up to 12 months | Peers' ratings of Educational Value of eConsults |
Countries
United States
Outcome results
None listed