Applying the Intention-Action Framework to Specialty Referrals

Part of paid clinical trials in Los Angeles, California.

Sponsor
University of California, Los Angeles
Study ID
NCT07671976
Status
Not Yet Recruiting

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Conditions

  • Cardiology
  • Gastroenterology
  • Pulmonology

Eligibility Criteria

Sex
ALL
Age
18 Years - N/A
Healthy Volunteers
Not accepted

Interventions

  • Information provision — BEHAVIORAL
    The order composer displays high-value criteria developed by UCLA Health using professional society guidelines and expert consensus from clinical leadership.
  • Auditing — BEHAVIORAL
    The order composer notifies physicians that their referral decisions may be subject to review.
  • Checklist — BEHAVIORAL
    The order composer includes cascading checkboxes that prompt physicians to confirm that referral criteria are met before submitting a referral. Physicians must actively indicate whether the patient meets referral criteria before submitting a referral. Physicians who determine that a referral remains clinically appropriate despite the patient not meeting listed criteria may select an option indicating that none of the listed criteria apply and provide a brief free-text explanation for proceeding with the referral.

Study Details

This is a prospective randomized controlled trial evaluating an EHR-embedded behavioral intervention intended to reduce low-value specialty referrals in cardiology, pulmonology, and gastroenterology. The intervention is designed to (1) strengthen physicians' intentions to avoid low-value specialty referrals at the point of encounter by presenting criteria for high-value referrals and informing physicians that referral decisions may be reviewed and (2) support follow-through on these intentions by modifying the referral process through structured checklist prompts embedded within the referral workflow. The primary hypothesis is that physicians exposed to the intervention will demonstrate lower rates of low-value cardiology, pulmonology, and gastroenterology referrals compared with physicians exposed to the arm where the order composer allows physicians to place referrals with minimal decision support.

Key Dates

Start date
Jul 1, 2026
Status verified
Jun 2026
Primary completion
Jan 1, 2027
Completion
Jan 31, 2027

Study Design

Enrollment
1,600 participants (estimated)
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH

Arms

  • No Intervention: Arm 1: Control
    Eligible, randomly assigned physicians use a basic order composer, which allows them to place referrals with minimal support.
  • Experimental: Arm 2: Information + Review
    Eligible, randomly assigned physicians use an order composer that displays criteria for high-value referrals and informs them that their referral decisions may be reviewed.
  • Experimental: Arm 3: Information + Review + Checklist
    Eligible, randomly assigned physicians use an order composer that displays high-value referral criteria, informs them that their referral decisions may be reviewed, and includes cascading checkboxes prompting them to confirm that referral criteria are met before submitting.

Primary Outcome Measure

Physician-level rate of low-value specialty referrals per 100 referral relevant encounters [ Time Frame: During 6-month intervention period ]

Central Contacts

Locations (1)

FacilityCityStateZIPSite coordinators
UCLA Health Department of MedicineLos AngelesCalifornia90095-

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UCLA Health Department of Medicine· Los Angeles, CA

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