This trial is active, not recruiting.

Conditions utilization, laboratory, hospital
Treatment normative report card
Sponsor University of Pennsylvania
Start date December 2015
End date June 2016
Trial size 154 participants
Trial identifier NCT02330289, 820924


Studies suggest that some laboratory tests ordered for hospitalized patients are duplicative or have limited value. This study will evaluate a normative feedback intervention to reduce overuse of laboratory tests for hospitalized patients by internal medicine physicians-in-training.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Intervention model parallel assignment
Masking single blind (outcomes assessor)
Primary purpose health services research
The intervention arm will receive an email report card describing their lab use compared to their peers as well as a link to a website visually tracking the team's daily ordering of common lab tests compared to the peer teams.
normative report card
Personalized visual report card describing physician's laboratory ordering pattern for prior week relative to peers as well as a link to a website tracking lab ordering for the team in real time compared to peer teams.
(No Intervention)
Physicians in the control arm will not receive the email or website link.

Primary Outcomes

Routine laboratory tests/patient-day
time frame: 6 months

Secondary Outcomes

Laboratory costs
time frame: 6 months
Routine imaging tests/patient-day
time frame: 6 months
Physicians' attitudes toward laboratory test use and receiving feedback
time frame: 6 months

Eligibility Criteria

Male or female participants of any age.

Inclusion Criteria: - Any internal medicine physician-in-training scheduled to rotate through general medicine services at HUP during the study period will be included in the study. Exclusion Criteria: - Physicians-in-training pulled for weekend coverage or sick coverage will be excluded. Medical students will be excluded.

Additional Information

Official title The Effect of Norms on Laboratory and Imaging Testing (ENLITen): a Pragmatic Randomized Controlled Trial
Principal investigator Kira L Ryskina, MD
Description Past research has shown that 25% of diagnostic testing is duplicative or has limited value. Academic medical centers that employ physicians-in-training may find it particularly challenging to reduce low value testing due to a historical emphasis on extensive workups by trainees. Despite the increased emphasis on cost-consciousness in medical education, there is little existing research evaluating ways to optimize ordering behaviors of physicians-in-training. This study will evaluate a normative feedback intervention for internal medicine physicians-in-training to reduce overuse of routine laboratory tests for hospitalized patients. Physicians-in-training will be cluster-randomized into two arms: (1) those who receive report cards (intervention group), (2) those who will not receive report cards (control group). We will study the use of routine laboratory tests over a pre-intervention period of 1 week and a post-randomization period of 1 week. We will study physician attitudes about the real-time feedback dashboard with qualitative assessments in focus groups after the completion of the intervention.
Trial information was received from ClinicalTrials.gov and was last updated in July 2016.
Information provided to ClinicalTrials.gov by University of Pennsylvania.