NCT04053335

Smarter Care Virginia, Examining Low-Value Care in Virginia

Completed Last updated 3 July 2023

What this trial tests

trial testing Multicomponent Physician Performance Peer-Comparison Feedback Intervention in Chronic Kidney Diseases in 5,000,000 participants. Completed in 31 December 2022.

Timeline

25 July 2019

Primary endpoint
31 December 2022

31 December 2022

Quick facts

Lead sponsor	University of California, Los Angeles
Status	Completed
Study type	OBSERVATIONAL
Enrollment	5,000,000
Start date	25 July 2019
Primary completion	31 December 2022
Estimated completion	31 December 2022
Sites	1 location across United States

Drugs / interventions tested

• Multicomponent Physician Performance Peer-Comparison Feedback Intervention

Conditions studied

• Chronic Kidney Diseases — all drugs for Chronic Kidney Diseases →
• Eye Diseases — all drugs for Eye Diseases →
• Cardiac Disease — all drugs for Cardiac Disease →
• Surgery — all drugs for Surgery →

Sponsor

University of California, Los Angeles

Who can join

18 and older, any sex, with Chronic Kidney Diseases or Eye Diseases. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Low-value care is defined as patient care that provides no net benefit to patients in specific clinical scenarios, and can cause patient harm. Prior research has documented high-rates of low-value care in Virginia; this work has helped to inspire a Virginia government-sponsored quality improvement initiative to reduce low-value care. Funded by an Arnold Ventures grant, six large health systems in Virginia volunteered to partner with the Virginia Center for Health Innovation (VCHI) to reduce use of nine low-value health services (three preoperative testing measures, two cardiac screening measures, one diagnostic eye imaging measure, one low-back pain opioid measure, one low-back pain imaging measure and one peripherally inserted central catheter \[PICC\] measure). These health systems include nearly 7000 clinicians practicing across more than 1000 sites.

VCHI is implementing a nonrandomized physician peer-comparison feedback quality improvement intervention to reduce use of nine low-value services. Modeling will be used to identify and use propensity score matching to match six intervention health systems to six comparable control health systems. VCHI will provide education, quality improvement training and financial resources to each site, and VCHI will use the Milliman MedInsight Health Waste Calculator to create the peer comparison reports using the Virginia All Payer Claims Database (APCD). VCHI will use additional measures from The Agency for Healthcare Research and Quality (AHRQ). Additionally, VCHI will use AHRQ data to attribute physicians and health care facilities to health systems.

The primary purpose of the initiative is to improve quality of care for Virginia residents and this initiative is not being done for research purposes. Nevertheless, University of California, Los Angeles (UCLA) plans to rigorously study and publish the impact of this intervention across the state of Virginia, which is why the UCLA team pre-registered the initiative. The UCLA team will use the Virginia APCD to evaluate the impact of the intervention. Please note: the APCD has a 1-year time-lag of data collection and is a dynamic database, meaning that its population of enrollees changes from year to year. This intervention was initially designed as a randomized step-wedge intervention; the intervention was delayed by the COVID-19 pandemic and began in September 2020 for all intervention groups. The intervention period was extended through December 2022. As a result, the initial design was modified.

Publications & conference data

No peer-reviewed publications indexed yet for this trial. Completed trials usually publish results within 12-18 months.