Panel Paper: Nudging Specialists in Value-Based Systems

Thursday, November 7, 2019
I.M Pei Tower: Majestic Level, Vail (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Daniella Meeker1, Mark William Friedberg2, Tara Knight1, Jason Doctor1, Dina Zein1, Nancy Cayasso-McIntosh3, Hal Yee3, Stanley Dea3 and Paul Giboney3, (1)University of Southern California, (2)RAND Corporation, (3)Los Angeles County

Electronic interprofessional consultations, or eConsults, allow Primary Care Providers (PCPs) and their patients to more quickly access specialist opinions and, in some cases, resolve patients’ clinical needs without waiting for face-to-face specialist visits. However, PCPs in the Los Angeles County eConsult system have noted substantial variability in the value of specialist eConsult responses. Specialists may improve their eConsults if given peer ratings of their own eConsult quality relative to others with whom they work. We devised an eConsult peer rating system and randomized 219 Los Angeles County specialists, who collectively responded to eConsult requests from 1381 PCPs, to perform peer ratings, receive peer rating feedback, or both over a 6-month intervention period. Each group provided ratings and received feedback about performance during different stages of the trial. Specialists rated their peers on 5 dimensions: quality of medical decision-making, institutional guideline adherence, relationship building, educational value, and elicitation of information from PCPs. After controlling for secular trends and rating participation, specialists receiving feedback demonstrated statistically significant improvements on 3 dimensions of eConsult quality: medical decision making (odds ratio 1.46, 95% confidence interval 1.06-1.98), educational value (1.68, 1.13-2.05), and relationship building (1.58, 1.22-2.21). Participating in the rating process was associated with non-significant improvements on all dimensions. These findings suggest the quality of specialist eConsults can be improved with peer feedback, and such feedback systems might be considered as specialists and health systems adopt eConsult systems.