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| Name | Class |
|---|---|
| Los Angeles County Department of Public Health | OTHER_GOV |
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Using behavioral economics, the study objective is to increase the efficiency, quality, and timeliness of care for Los Angeles County (LAC) Department of Health Services (DHS) patients by nudging specialists toward more effective use of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care.
Historically, the Los Angeles County (LAC) Department of Health Services (DHS) Safety Net system has faced challenges in delivering specialty services that are timely, geographically equitable, and coordinated in a patient centered manner. Recently, LACDHS improved infrastructure through implementation of eConsult, a web-based consultation and communication portal for Primary Care Providers (PCPs) and specialists, improving access for patients in greatest need of specialty care. The study investigators will conduct a pragmatic randomized trial with the goal of increasing the efficiency, quality, and timeliness of care for LACDHS patients by nudging specialists toward more effective use of eConsult. If successful, these nudges may reduce the number and increase the value of face-to-face consults.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Rating tool only | Experimental | Rating eConsults from peer specialists in first phase |
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| Feedback only | Experimental | Receiving feedback from peer specialists in first phase |
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| Rating Tool plus Feedback | Experimental | Both rating and feedback in second phase. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rating tool | Behavioral | eConsult Specialty Reviewers are asked to rate the quality of other specialists' recently completed eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange) |
| Measure | Description | Time Frame |
|---|---|---|
| Rating - Medical Decision Making | Peers' ratings of Medical Decision Making in Specialists' responses to PCPs | Baseline to Post-Intervention, up to 12 months |
| Rating - Application of Expected Practices | Peers' ratings of Expected Practices in Specialists' responses to PCPs | Baseline to Post-Intervention, up to 12 months |
| Rating - Relationship Building | Peers' ratings Relationship Building in Specialists' responses to PCPs | Baseline to Post-Intervention, up to 12 months |
| Rating - Expert Elicitation | Peers' ratings of Specialists' skill in elicitation of information from PCPs | Baseline to Post-Intervention, up to 12 months |
| Rating - Educational Value | Peers' ratings of Educational Value of eConsults | Baseline to Post-Intervention, up to 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Daniella Meeker, PhD | University of Southern California | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Los Angeles County Department of Health Services | Los Angeles | California | 90012 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28264951 | Background | Barnett ML, Yee HF Jr, Mehrotra A, Giboney P. Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists. Health Aff (Millwood). 2017 Mar 1;36(3):492-499. doi: 10.1377/hlthaff.2016.1283. | |
| 29801079 | Background | Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis. JAMA Intern Med. 2018 Jun 1;178(6):782-789. doi: 10.1001/jamainternmed.2018.0738. |
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| Feedback | Behavioral | eConsult Specialty Reviewers receive confidential feedback via email on their performance (top performer vs not a top performer) as compared to colleagues in their specialty. Feedback is based on other reviewers ratings of their eConsult exchanges on the following four dimensions: 1) efforts to elicit additional information from PCPs, when needed; 2) medical decision making; 3) inclusion of educational content for PCPs, when appropriate; 4) perceived effect on the PCP-specialist relationship (i.e., overall tone of the eConsult exchange) |
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| 34505234 | Derived | Behavioral Economics and eConsult Steering Committee; Meeker D, Friedberg MW, Knight TK, Doctor JN, Zein D, Cayasso-McIntosh N, Goldstein NJ, Fox CR, Linder JA, Persell SD, Dea S, Giboney P, Yee HF. Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial. J Gen Intern Med. 2022 May;37(6):1400-1407. doi: 10.1007/s11606-021-07002-1. Epub 2021 Sep 9. |