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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
16
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.
University of Michigan and other Michigan Surgical Quality Collaborative sites
Ann Arbor, Michigan, United States
RECRUITINGNumber 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
Time frame: Within 30 days of surgery
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
Time frame: Up to year 2, quarter 4
30-day episode-based spending
Using the MVC claims data for total spending amounts
Time frame: 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
Time frame: Up to year 2, quarter 4
Number of intraoperative complications
Examples: myocardial infarction, stroke
Time frame: Up to year 2, quarter 4
Number of same-day case cancellations
Time frame: Up to year 2, quarter 4
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