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Using Behavioral Economics to Reduce Low-Value Care
NA trial testing Nudge #1: Alert highlighting the safety/potential harms to patients of undergoing pre-op tests in Pre-Operative Testing for Cataract Surgery in 1,045 participants. Completed in 14 August 2023.
| Lead sponsor | University of California, Los Angeles |
|---|---|
| Phase | NA |
| Status | Completed |
| Study type | INTERVENTIONAL |
| Allocation | randomized |
| Design | parallel |
| Masking | double |
| Primary purpose | health services research |
| Enrollment | 1,045 |
| Start date | 24 June 2021 |
| Primary completion | 11 April 2023 |
| Estimated completion | 14 August 2023 |
| Sites | 1 location across United States |
University of California, Los Angeles
18 and older, any sex, with Pre-Operative Testing for Cataract Surgery. Patients with the condition only — healthy volunteers not accepted.
Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.
Change in percentage of patients undergoing pre-operative testing (labs, EKG, CXR)
| Group | Value | 95% CI |
|---|---|---|
| Alert 1 | 87.4 | ± 33.2 |
| Alert 2 | 85.0 | ± 35.8 |
| Alert 3 | 86.1 | ± 34.6 |
| Control | 85.4 | ± 35.4 |
| Group | Value | 95% CI |
|---|---|---|
| Alert 1 | 84.6 | ± 36.2 |
| Alert 2 | 80.3 | ± 39.9 |
| Alert 3 | 79.8 | ± 40.3 |
| Control | 83.5 | ± 37.2 |
Time frame: Post-Intervention (3 Months) Patients were monitored for the completion of their cataract surgery following their pre-op visit. Adverse events were then monitored/assessed for 12 weeks following the completion of their cataract surgery.. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.
| Reaction | System | Alert 1 | Alert 2 | Alert 3 | Control |
|---|---|---|---|---|---|
| Inpatient Admission | General disorders | — | — | — | — |
| Reaction | System | Alert 1 | Alert 2 | Alert 3 | Control |
|---|---|---|---|---|---|
| Emergency Department visits that did not require admissions | General disorders | — | — | — | — |
Most-reported serious reactions: Inpatient Admission.
Data from ClinicalTrials.gov NCT04104256 adverse events section.
There is strong consensus - based on robust randomized trial data - that routine pre-operative (pre-op) testing for cataract surgery is inappropriate. Despite these widely endorsed evidence-based recommendations, most seniors undergoing cataract surgery still receive unnecessary blood testing, EKGs, and chest X-rays (CXRs); another substantial percentage even undergo nonindicated cardiac stress tests. We will integrate three new best practice alert (BPA) nudges into the University of California, Los Angeles (UCLA) Health electronic health record (EHR). The nudges are informed by behavioral economic theory and are designed to alter the choice architecture for physicians to decrease the rate of pre-op test ordering while still preserving clinician autonomy. We will conduct a pragmatic trial to evaluate whether these BPA nudges reduce low-value pre-op testing for cataract surgery.
1 peer-reviewed publication reference this trial (live from Europe PMC):
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