Ignite Creation Date:
2024-05-06 @ 7:51 PM
Last Modification Date:
2024-10-26 @ 3:15 PM
Study NCT ID:
NCT06155292
Status:
RECRUITING
Last Update Posted:
2024-05-16
First Post:
2023-10-03
Brief Title:
Report Cards and Feedback for PCCE
Sponsor:
University of California Los Angeles
Organization:
University of California Los Angeles
Study Overview
Official Title:
The Effect of Personalized Report Cards and Bottom-up Framing on PCCE Performance and Attitudes
Status:
RECRUITING
Status Verified Date:
2024-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
RCF PCCE
Brief Summary:
As part of UCLA Healths commitment to developing an integrated health system built on a foundation of physician-led team-based primary care the Department of Medicine DOM implemented a performance-based incentive plan called the Primary Care Clinical Excellence PCCE Incentive Plan
The UCLA Health DOM Quality team is leading the implementation and evaluation of this incentive plan across the UCLA Health primary care network with the primary goal to immediately produce improvements in the quality of primary care In order to rigorously measure the most efficacious ways to frame and communicate information about the quality improvement QI program the DOM Quality team has partnered with the UCLA Anderson School of Management
Understanding the factors that motivate physicians to deliver high quality primary care will provide pivotal insights into the successful implementation of performance based programs nationwide
The UCLA Health DOM Quality team is leading the implementation and evaluation of this incentive plan across the UCLA Health primary care network with the primary goal to immediately produce improvements in the quality of primary care In order to rigorously measure the most efficacious ways to frame and communicate information about the quality improvement QI program the DOM Quality team has partnered with the UCLA Anderson School of Management
Understanding the factors that motivate physicians to deliver high quality primary care will provide pivotal insights into the successful implementation of performance based programs nationwide
Detailed Description:
The investigators will use a communication strategy that leverages behavioral principles to motivate providers to improve in all four of the evaluated domains of the PCCE program clinical quality professional participation patient experience and risk coding
The investigators will implement a three-arm experimental communication campaign that includes quarterly emails and quarterly survey messages The communication strategies will utilize motivation and behavior change theories to improve physician performance in the program and attitudes towards the program In particular the investigators will test the independent and joint effects of communicating with physicians a personalized performance feedback and b the co-creation of the program ie sharing how physician feedback informed the program design
The investigators will randomly assign eligible physicians to one of the three experimental arms stratified by overall baseline performance the total percent allocated in the PCCE program for the April May June 2023 quarter specialty based on classification as Adult or AdultPeds and contract based on classification as DOM or PCN CPNEIMG
The investigators will evaluate whether arm 3 differs from arm 1 in terms of the measures listed in the Outcome Measures section If this comparison is statistically significant the investigators will next compare arms 3 vs 2 and arms 2 vs 1
Analysis plan
Physician-quarter-level linear regression models with heteroskedastic-consistent robust standard errors clustered at the physician level
The primary model term will be indicator variables for arms that patients are assigned to
Control variables
Baseline values of the outcome measure the investigators will control for the baseline measures of the outcomes based on performance from July through September 2023 and survey responses in April and July 2023 if available
Physician baseline subjective understanding of the PCCE program from the July 2023 survey with four items which asked the extent to which physicians understood how their score in each domain of the program was calculated
Physician characteristics self-reported gender race and age plus years at UCLA Health and clinic from administrative data
Missing covariate values will be handled by including unknown indicator variables along with mean imputation for continuous covariates
Exploratory analyses will investigate heterogeneous treatment effects by the following characteristics
Physician baseline performance in the PCCE program evaluated based on performance in July August and September 2023
Physician baseline perceived leadership support reported in the July 2023 survey
Physician baseline program-related attitudes agency value in PCCE program reported in the April 2023 survey
Physician baseline subjective understanding of the PCCE program from the July 2023 survey
Objective valence of the feedback delivered in the first email report card measured by 1 the number of metrics within each domain for which the physician improved relative to the prior quarter 2 the number of metrics within each domain for which the physician met or exceeded the benchmark and 3 average distance from the benchmark across the metrics within each domain
Random assignment to providing feedback on the report card design in a survey conducted before the intervention launch in July 2023
Physician gender
Physician years in practice
The investigators will investigate physicians program-related attitudes and perceptions as proposed mechanisms of the interventions These will be measured with 11 items that form three subscales about perceived justice antecedents to ones intentions to succeed and perceived value of the feedback
Perceived justice in the PCCE program structure and implementation Physicians will be surveyed regarding the structural justice 2 items distributive justice 1 item and informational justice of the program 2 items
Antecedents of intentions to succeed in the program Physicians will be surveyed regarding their perceived agency behavioral control over their performance in the PCCE program 1 item their perceived value of the PCCE program 2 items and their subjective norms about the endorsement and success of their colleagues in the program 2 items
Perceived value of the performance feedback Physicians will be surveyed about the utility of the quarterly performance feedback in contextualizing their goal pursuit efforts 1 item
The investigators will investigate physicians overall workplace attitudes as additional outcomes These will be measured as a 4-item questionnaire about trust in UCLA Health leadership 1 item perceived leadership support 1 item job satisfaction 1 item and burnout 1 item
Robustness checks will be performed without covariates and using logistic regression models in place of linear regression models for dependent variables that are measured as binary indicators
The investigators will implement a three-arm experimental communication campaign that includes quarterly emails and quarterly survey messages The communication strategies will utilize motivation and behavior change theories to improve physician performance in the program and attitudes towards the program In particular the investigators will test the independent and joint effects of communicating with physicians a personalized performance feedback and b the co-creation of the program ie sharing how physician feedback informed the program design
The investigators will randomly assign eligible physicians to one of the three experimental arms stratified by overall baseline performance the total percent allocated in the PCCE program for the April May June 2023 quarter specialty based on classification as Adult or AdultPeds and contract based on classification as DOM or PCN CPNEIMG
The investigators will evaluate whether arm 3 differs from arm 1 in terms of the measures listed in the Outcome Measures section If this comparison is statistically significant the investigators will next compare arms 3 vs 2 and arms 2 vs 1
Analysis plan
Physician-quarter-level linear regression models with heteroskedastic-consistent robust standard errors clustered at the physician level
The primary model term will be indicator variables for arms that patients are assigned to
Control variables
Baseline values of the outcome measure the investigators will control for the baseline measures of the outcomes based on performance from July through September 2023 and survey responses in April and July 2023 if available
Physician baseline subjective understanding of the PCCE program from the July 2023 survey with four items which asked the extent to which physicians understood how their score in each domain of the program was calculated
Physician characteristics self-reported gender race and age plus years at UCLA Health and clinic from administrative data
Missing covariate values will be handled by including unknown indicator variables along with mean imputation for continuous covariates
Exploratory analyses will investigate heterogeneous treatment effects by the following characteristics
Physician baseline performance in the PCCE program evaluated based on performance in July August and September 2023
Physician baseline perceived leadership support reported in the July 2023 survey
Physician baseline program-related attitudes agency value in PCCE program reported in the April 2023 survey
Physician baseline subjective understanding of the PCCE program from the July 2023 survey
Objective valence of the feedback delivered in the first email report card measured by 1 the number of metrics within each domain for which the physician improved relative to the prior quarter 2 the number of metrics within each domain for which the physician met or exceeded the benchmark and 3 average distance from the benchmark across the metrics within each domain
Random assignment to providing feedback on the report card design in a survey conducted before the intervention launch in July 2023
Physician gender
Physician years in practice
The investigators will investigate physicians program-related attitudes and perceptions as proposed mechanisms of the interventions These will be measured with 11 items that form three subscales about perceived justice antecedents to ones intentions to succeed and perceived value of the feedback
Perceived justice in the PCCE program structure and implementation Physicians will be surveyed regarding the structural justice 2 items distributive justice 1 item and informational justice of the program 2 items
Antecedents of intentions to succeed in the program Physicians will be surveyed regarding their perceived agency behavioral control over their performance in the PCCE program 1 item their perceived value of the PCCE program 2 items and their subjective norms about the endorsement and success of their colleagues in the program 2 items
Perceived value of the performance feedback Physicians will be surveyed about the utility of the quarterly performance feedback in contextualizing their goal pursuit efforts 1 item
The investigators will investigate physicians overall workplace attitudes as additional outcomes These will be measured as a 4-item questionnaire about trust in UCLA Health leadership 1 item perceived leadership support 1 item job satisfaction 1 item and burnout 1 item
Robustness checks will be performed without covariates and using logistic regression models in place of linear regression models for dependent variables that are measured as binary indicators
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None