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Effect of Targeted Interventions to Improve Value Based Health Care for Inpatient Cardiology Patients

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ClinicalTrials.gov Identifier: NCT03173157
Recruitment Status : Completed
First Posted : June 1, 2017
Last Update Posted : August 10, 2018
Sponsor:
Information provided by (Responsible Party):
Adam Kingeter, Vanderbilt University Medical Center

Brief Summary:
The investigators hypothesize that a combined didactic and data feedback program presenting evidence based indications and in-hospital-charges for echocardiograms to inpatient cardiology team members will lead to increased health care value for patients on inpatient cardiology teams.

Condition or disease Intervention/treatment Phase
Heart Failure Heart Diseases Other: Value Feedback Email Not Applicable

Detailed Description:

The cost of healthcare in the United States has risen precipitously over the last forty years. In 2014, healthcare spending surpassed $3 trillion and accounted for 17.5 percent of the national gross domestic product. The Institute of Medicine's report "Best Care at Lower Cost" estimated that 30 percent, or approximately $900 billion in 2014, of healthcare expenditures are wasted. Given this wasted spending, great urgency has been placed on curbing the ever-increasing cost of healthcare while simultaneously improving quality and patient safety. Despite improvements in mortality associated with cardiovascular disease over the last two decades, the cost of cardiovascular care continues to rise and is estimated to be in excess of $186 billion by 2023. A number of studies have been performed evaluating the cost-effectiveness and appropriate use of routine transthoracic echocardiography; nonetheless, there is little evidence that the results of these studies have been translated into clinical practice. In order to close the gap between the literature and clinical practice, we plan to initiate a combined didactic and data feedback program that will present the current literature and in-hospital charges associated with echocardiography to practicing clinicians on inpatient cardiology services. We will measure the effect of our intervention on average per-patient in-hospital charges as well as usage rates and other clinical outcomes.

Research Design and Methods: The investigators will perform a prospective, controlled cohort study period comparing the effect of a combined didactic and data feedback intervention on in-hospital charges, usage rates, and clinical outcomes to providers. The investigator's intervention will consist of a biweekly email to three house staff-run cardiology services at VUMC presenting the in-hospital charges and appropriate use of echocardiography per ACC/AHA guidlines. A weekly email will also be sent to the intervention services detailing their team's in-hospital charges for echocardiograms during the preceding week. Usage and in-hospital charges will be measured using a custom tableau which captures all orders placed in the HeoWiz ordering program and the raw master charges. The investigators will utilize a pre and post intervention design to study primary and secondary outcomes. The primary outcome will be average echocardiography charges per team. The secondary outcomes will be echocardiograms performed per team per month, and number of focused echocardiograms performed per team per month. Quality of care will be assessed by monitoring 30 day readmission rate, and index hospitalization mortality.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 183 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Effect of Targeted Interventions to Improve Value Based Health Care for Inpatient Cardiology Patients: A Choosing Wisely Initiative
Actual Study Start Date : February 27, 2017
Actual Primary Completion Date : November 1, 2017
Actual Study Completion Date : December 31, 2017

Arm Intervention/treatment
Experimental: Value Feedback Arm
A weekly email will be sent to all inpatient, resident-staffed cardiology teams outlining best use practices from AHA/ACC statements on trans-thoracic echoacardiography and data feedback on in-hospital charges, running 13 week average usage and previous week usage of full and limited trans thoracic echocardiograms
Other: Value Feedback Email
a biweekly email to three house staff-run cardiology services at VUMC presenting the in-hospital charges and appropriate use of echocardiography. A weekly email will also be sent to the intervention services detailing their team's in-hospital charges for echocardiograms during the preceeding week.




Primary Outcome Measures :
  1. Average echocardiography charges per inpatient team [ Time Frame: 30 days ]
    Average echocardiography charges per inpatient team per month


Secondary Outcome Measures :
  1. Average number of complete transthoracic echocardiograms per inpatient team [ Time Frame: 30 days ]
    Average number of complete transthoracic echocardiograms per inpatient team per month

  2. Average number of focused transthoracic echocardiograms per inpatient team [ Time Frame: 30 days ]
    Average number of focused transthoracic echocardiograms per inpatient team per month


Other Outcome Measures:
  1. Readmission rate [ Time Frame: 30 day ]
    Readmission rate for patients admitted to inpatient cardiology teams

  2. Index hospitalization mortality [ Time Frame: 30 day ]
    mortality rate for patients admitted to inpatient cardiology teams



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • All residents rotation through inpatient cardiology teams at a large academic medical center

Exclusion Criteria:

  • Residents who elect to not recieve feedback email

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03173157


Locations
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United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States, 37212
Sponsors and Collaborators
Vanderbilt University Medical Center

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Responsible Party: Adam Kingeter, Assistant Professor, Vanderbilt University Medical Center
ClinicalTrials.gov Identifier: NCT03173157     History of Changes
Other Study ID Numbers: 162135
First Posted: June 1, 2017    Key Record Dates
Last Update Posted: August 10, 2018
Last Verified: August 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Heart Diseases
Cardiovascular Diseases