Evidence map›Paper›PMID 29066616›Full record

Trial reportBMJ quality & safety2018

Precommitting to choose wisely about low-value services: a stepped wedge cluster randomised trial.

Jeffrey Todd Kullgren, Erin Krupka, Abigail Schachter, Ariel Linden, Jacquelyn Miller, Yubraj Acharya, James Alford, Richard Duffy, Julia Adler-Milstein

2 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 26 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02247050 nacompletednot on this map

Primary Care Clinician Commitments to Choosing Wisely®

TypeinterventionalSponsorUniversity of MichiganRan2014 to 2015Enrolled45ConditionsHealth Services Misuse, Physician's Practice Patterns, Guideline Adherence, Unnecessary ProceduresArmsCommitment invitation
NCT05026684 naunknown statusnot on this mapstarted 2021, after this paper: background citation

Achieving Greater Value for Veterans Through Full Cost Transparency

TypeinterventionalSponsorVA Ann Arbor Healthcare SystemRan2021 to 2022Enrolled150ConditionsDelivery of Health CareArmsPersonalized cost handout
3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  5. Defining and measuring imaging appropriateness in low back pain studies: a scoping review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2020
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  11. Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial.Journal of the American Medical Informatics Association : JAMIA · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Jeffrey Todd KullgrenCenter for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.ORCID 0000-0001-6269-5707
Erin KrupkaSchool of Information, University of Michigan, Ann Arbor, MI, USA.
Abigail SchachterSchool of Public Health, University of Michigan, Ann Arbor, MI, USA.
Ariel LindenLinden Consulting Group, Ann Arbor, Michigan, USA.
Jacquelyn MillerCenter for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Yubraj AcharyaSchool of Public Health, University of Michigan, Ann Arbor, MI, USA.
James AlfordDivision of Family Medicine, IHA, Ann Arbor, Michigan, USA.
Richard DuffyDivision of Quality and Performance Improvement, IHA, Ann Arbor, MI, USA.
Julia Adler-MilsteinInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLittle is known about how to discourage clinicians from ordering low-value services. Our objective was to test whether clinicians committing their future selves (ie, precommitting) to follow

methodsWe conducted a 12-month stepped wedge cluster randomised trial among 45 primary care physicians and advanced practice providers in six adult primary care clinics of a US community group practice.Clinicians were invited to precommit to

resultsThe intervention was not associated with a change in the percentage of visits with potentially low-value orders overall, for headaches or for acute sinusitis, but was associated with a 1.7% overall increase in alternate orders (p=0.01). For low back pain, the intervention was associated with a 1.2% decrease in the percentage of visits with potentially low-value orders (p=0.001) and a 1.9% increase in the percentage of visits with alternate orders (p=0.007). No changes were sustained in follow-up.

conclusionClinician precommitment to follow TRIAL REGISTRATION NUMBER: NCT02247050; Pre-results.

Indexed as

AdultAttitude of Health PersonnelClinical Decision-MakingCommunicationDecision Support TechniquesElectronic Health RecordsFemaleGuideline AdherenceHealth PersonnelHumansMaleMedical OveruseMiddle AgedPatient Education as TopicPhysiciansPractice Guidelines as Topicambulatory caredecision makingdecision support, clinicalhealth services researchprimary care

Identifiers

PMID29066616

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.