Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
J Gen Intern Med. 2018 Oct;33(10):1639-1645. doi: 10.1007/s11606-018-4482-y. Epub 2018 May 22.
Social comparison feedback is an increasingly popular strategy that uses performance report cards to modify physician behavior. Our objective was to test the effect of such feedback on the ordering of routine laboratory tests for hospitalized patients, a practice considered overused.
This was a single-blinded randomized controlled trial. Between January and June 2016, physicians on six general medicine teams at the Hospital of the University of Pennsylvania were cluster randomized with equal allocation to two arms: (1) those e-mailed a summary of their routine laboratory test ordering vs. the service average for the prior week, linked to a continuously updated personalized dashboard containing patient-level details, and snapshot of the dashboard and (2) those who did not receive the intervention. The primary outcome was the count of routine laboratory test orders placed by a physician per patient-day. We modeled the count of orders by each physician per patient-day after the intervention as a function of trial arm and the physician's order count before the intervention. The count outcome was modeled using negative binomial models with adjustment for clustering within teams.
One hundred and fourteen interns and residents participated. We did not observe a statistically significant difference in adjusted reduction in routine laboratory ordering between the intervention and control physicians (physicians in the intervention group ordered 0.14 fewer tests per patient-day than physicians in the control group, 95% CI - 0.56 to 0.27, p = 0.50). Physicians whose absolute ordering rate deviated from the peer rate by more than 1.0 laboratory test per patient-day reduced their laboratory ordering by 0.80 orders per patient-day (95% CI - 1.58 to - 0.02, p = 0.04).
Personalized social comparison feedback on routine laboratory ordering did not change targeted behavior among physicians, although there was a significant decrease in orders among participants who deviated more from the peer rate.
Clinicaltrials.gov registration: #NCT02330289.
社会比较反馈是一种越来越流行的策略，它使用绩效报告卡来改变医生的行为。我们的目的是测试这种反馈对住院患者常规实验室检查的医嘱的影响，这种做法被认为是过度使用的。
这是一项单盲随机对照试验。2016 年 1 月至 6 月期间，宾夕法尼亚大学医院的六支普通内科团队的医生被按比例分配到两个组：（1） 那些收到他们常规实验室检查医嘱与前一周服务平均值的电子邮件摘要的医生，链接到一个包含患者详细信息的不断更新的个性化仪表板，以及仪表板的快照；（2） 那些没有收到干预措施的医生。主要结果是每位医生每患者天的常规实验室检查医嘱数量。我们将干预后每位医生每患者天的医嘱数量建模为试验臂和医生干预前的医嘱数量的函数。计数结果使用负二项式模型进行建模，并对团队内的聚类进行了调整。
114 名实习医生和住院医生参与了研究。我们没有观察到干预组和对照组医生在常规实验室检查医嘱减少方面有统计学上的显著差异（干预组医生每患者天的医嘱数量比对照组医生少 0.14 个，95%置信区间为-0.56 至 0.27，p=0.50）。那些医嘱绝对数量与同行偏差超过 1.0 个实验室测试的医生，其医嘱数量减少了 0.80 个测试/患者天（95%置信区间为-1.58 至-0.02，p=0.04）。
针对常规实验室医嘱的个性化社会比较反馈并没有改变医生的目标行为，尽管与同行偏差较大的参与者的医嘱数量有显著减少。
Clinicaltrials.gov 注册号：NCT02330289。
