Breast Lumpectomy, Inguinal Hernia Repair, Laparoscopic Cholecystectomy
Conditions
Keywords
Preoperative testing
Brief summary
This trial aims to evaluate the effectiveness of a multi-level, multi-component de-implementation strategy to reduce unnecessary preoperative testing. Sixteen Michigan Value Collaborative (MVC)/Michigan Surgical Quality Collaborative (MSQC) sites in Michigan will implement several tools that have been proven to reduce unnecessary testing at a single site, including clinician education, a decision aid, audit and feedback on performance, and a pay-for-performance incentive. The researchers believe that, through the use of these strategies, there will be a significant reduction in unnecessary preoperative testing during the intervention.
Interventions
BEHAVIORALActive de-Implementation
During active de-implementation (3 months), the local team will distribute the strategy components (i.e., clinician education, decision support, evaluation, consensus building around perioperative testing pathways, facility-specific feedback, and a pay-for-performance incentive) at the local site.
Sponsors
University of Michigan
Agency for Healthcare Research and Quality (AHRQ)
Blue Cross Blue Shield of Michigan Foundation
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Using a stepped wedge design, sixteen Michigan Value Collaborative (MVC)/Michigan Surgical Quality Collaborative (MSQC) sites in Michigan will implement a multi-level, multi-component de-implementation strategy and collect information on the use of unnecessary preoperative testing.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Site Inclusion Criteria: * Over 30% of testing rates on at least one of the three index procedures (breast lumpectomy, laparoscopic cholecystectomy, and inguinal hernia repair)
Exclusion criteria
* none Surgical participants must be over 18 years old.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of tests within 30 days of surgery not associated with an emergency department visit | Within 30 days of surgery | Only tests relating to three index procedures; breast lumpectomy, laparoscopic cholecystectomy, and inguinal hernia repair Data collected using MVC/MSQC database |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of unnecessary preoperative testing before low-risk surgery at MVC/MSQC sites not participating in the trial | Up to year 2, quarter 4 | Example related operations: laparoscopic hysterectomy, knee arthroscopy |
| 30-day episode-based spending | Up to Year 2, Quarter 2 | Using the MVC claims data for total spending amounts |
| Number of unnecessary preoperative testing before low-risk surgery at trial sites | Up to year 2, quarter 4 | Example related operations: laparoscopic hysterectomy, knee arthroscopy |
| Number of intraoperative complications | Up to year 2, quarter 4 | Examples: myocardial infarction, stroke |
| Number of same-day case cancellations | Up to year 2, quarter 4 | — |
Countries
United States
Contacts
CONTACTDana Greene Jr., MPH
CONTACTValerie Gavrila
PRINCIPAL_INVESTIGATORLesly Dossett, MD, MPH
University of Michigan
PRINCIPAL_INVESTIGATORHari Nathan, PhD
University of Michigan
Outcome results
None listed