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| ID | Type | Description | Link |
|---|---|---|---|
| R01HS029306 | U.S. AHRQ Grant/Contract | View source |
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| Name | Class |
|---|---|
| Agency for Healthcare Research and Quality (AHRQ) | FED |
| Blue Cross Blue Shield of Michigan Foundation | OTHER |
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This trial aims to evaluate the effectiveness of a multi-level, multi-component de-implementation strategy to reduce unnecessary preoperative testing. Sixteen Michigan Value Collaborative (MVC)/Michigan Surgical Quality Collaborative (MSQC) sites in Michigan will implement several tools that have been proven to reduce unnecessary testing at a single site, including clinician education, a decision aid, audit and feedback on performance, and a pay-for-performance incentive. The researchers believe that, through the use of these strategies, there will be a significant reduction in unnecessary preoperative testing during the intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Wave 1 | Experimental | Each wave will include usual care, preparation (8 weeks before intervention), active de-implementation interventions, and sustainment phases. Intervention is Year 1 Quarter 2 |
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| Wave 2 | Experimental | Each wave will include usual care, preparation (8 weeks before intervention), active de-implementation interventions, and sustainment phases. Intervention is Year 1 Quarter 3 |
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| Wave 3 | Experimental | Each wave will include usual care, preparation (8 weeks before intervention), active de-implementation interventions, and sustainment phases. Intervention is Year 1 Quarter 4 |
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| Wave 4 | Experimental | Each wave will include usual care, preparation (8 weeks before intervention), active de-implementation interventions, and sustainment phases. Intervention is Year 2 Quarter 1 |
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| Wave 5 | Experimental | Each wave will include usual care, preparation (8 weeks before intervention), active de-implementation interventions, and sustainment phases. Intervention is Year 2 Quarter 2 |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Active de-Implementation | Behavioral | During active de-implementation (3 months), the local team will distribute the strategy components (i.e., clinician education, decision support, evaluation, consensus building around perioperative testing pathways, facility-specific feedback, and a pay-for-performance incentive) at the local site. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of tests within 30 days of surgery not associated with an emergency department visit | Only tests relating to three index procedures; breast lumpectomy, laparoscopic cholecystectomy, and inguinal hernia repair Data collected using MVC/MSQC database | Within 30 days of surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Number of unnecessary preoperative testing before low-risk surgery at MVC/MSQC sites not participating in the trial | Example related operations: laparoscopic hysterectomy, knee arthroscopy | Up to year 2, quarter 4 |
| 30-day episode-based spending |
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Site
Inclusion Criteria:
Exclusion Criteria:
Surgical participants must be over 18 years old.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dana Greene Jr., MPH | Contact | (313)-670-0408 | greenejr@med.umich.edu | |
| Valerie Gavrila | Contact | 734-232-9961 | gavrilva@umich.edu |
| Name | Affiliation | Role |
|---|---|---|
| Lesly Dossett, MD, MPH | University of Michigan | Principal Investigator |
| Hari Nathan, PhD | University of Michigan | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Michigan and other Michigan Surgical Quality Collaborative sites | Recruiting | Ann Arbor | Michigan | 48109 | United States |
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Using a stepped wedge design, sixteen Michigan Value Collaborative (MVC)/Michigan Surgical Quality Collaborative (MSQC) sites in Michigan will implement a multi-level, multi-component de-implementation strategy and collect information on the use of unnecessary preoperative testing.
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| Wave 6 | Experimental | Each wave will include usual care, preparation (8 weeks before intervention), active de-implementation interventions, and sustainment phases. Intervention is Year 2 Quarter 3 |
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Using the MVC claims data for total spending amounts
| Up to Year 2, Quarter 2 |
| Number of unnecessary preoperative testing before low-risk surgery at trial sites | Example related operations: laparoscopic hysterectomy, knee arthroscopy | Up to year 2, quarter 4 |
| Number of intraoperative complications | Examples: myocardial infarction, stroke | Up to year 2, quarter 4 |
| Number of same-day case cancellations | Up to year 2, quarter 4 |