Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial
Introduction Opioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different be...
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BMJ Publishing Group
2024-03-01
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| author | Rachelle Buchbinder Matthew Smith Ian A Harris Enrico Coiera Adrian C Traeger Chris G Maher Kirsten Howard Kirsten McCaffery Qiang Li Jeffrey A Linder James McAuley Louise Cullen Ian Ferguson Sweekriti Sharma Elise Tcharkhedian Janet Harrison Naren Gunja Gustavo Machado Richard McNulty Mark Salter Paul M Middleton Ahilan Parameswaran Kitty Duong Andrew Coggins Zoe Michaleff Gemma Altinger Trevor Chan Karen Tambree Ajay Varshney Jeremy Lawrence Kevin Pile Richard Cracknell Kara Goon Daryn Mitford Raymond Morgan James Mallows Kelly Bivona Helen Zaouk Brendon Shapter Jim Basilakis Helen Badge Michael Meller Robyn Linder |
| author_facet | Rachelle Buchbinder Matthew Smith Ian A Harris Enrico Coiera Adrian C Traeger Chris G Maher Kirsten Howard Kirsten McCaffery Qiang Li Jeffrey A Linder James McAuley Louise Cullen Ian Ferguson Sweekriti Sharma Elise Tcharkhedian Janet Harrison Naren Gunja Gustavo Machado Richard McNulty Mark Salter Paul M Middleton Ahilan Parameswaran Kitty Duong Andrew Coggins Zoe Michaleff Gemma Altinger Trevor Chan Karen Tambree Ajay Varshney Jeremy Lawrence Kevin Pile Richard Cracknell Kara Goon Daryn Mitford Raymond Morgan James Mallows Kelly Bivona Helen Zaouk Brendon Shapter Jim Basilakis Helen Badge Michael Meller Robyn Linder |
| collection | DOAJ |
| description | Introduction Opioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different behavioural ‘nudge’ interventions on low-value care for ED patients with low back pain.Methods and analysis NUDG-ED is a 2×2 factorial, open-label, before-after, cluster randomised controlled trial. The trial includes 8 ED sites in Sydney, Australia. Participants will be ED clinicians who manage back pain, and patients who are 18 years or over presenting to ED with musculoskeletal back pain. EDs will be randomly assigned to receive (i) patient nudges, (ii) clinician nudges, (iii) both interventions or (iv) no nudge control. The primary outcome will be the proportion of encounters in ED for musculoskeletal back pain where a person received a non-indicated lumbar imaging test, an opioid at discharge or both. We will require 2416 encounters over a 9-month study period (3-month before period and 6-month after period) to detect an absolute difference of 10% in use of low-value care due to either nudge, with 80% power, alpha set at 0.05 and assuming an intra-class correlation coefficient of 0.10, and an intraperiod correlation of 0.09. Patient-reported outcome measures will be collected in a subsample of patients (n≥456) 1 week after their initial ED visit. To estimate effects, we will use a multilevel regression model, with a random effect for cluster and patient, a fixed effect indicating the group assignment of each cluster and a fixed effect of time.Ethics and dissemination This study has ethical approval from Southwestern Sydney Local Health District Human Research Ethics Committee (2023/ETH00472). We will disseminate the results of this trial via media, presenting at conferences and scientific publications.Trial registration number ACTRN12623001000695. |
| first_indexed | 2024-04-24T13:52:18Z |
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| spelling | doaj.art-29d8c75ede20499aa52fff29b45ef6612024-04-04T02:10:08ZengBMJ Publishing GroupBMJ Open2044-60552024-03-0114310.1136/bmjopen-2023-079870Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial Rachelle Buchbinder0Matthew Smith1Ian A Harris2Enrico Coiera3Adrian C Traeger4Chris G Maher5Kirsten Howard6Kirsten McCaffery7Qiang Li8Jeffrey A Linder9James McAuley10Louise Cullen11Ian Ferguson12Sweekriti Sharma13Elise Tcharkhedian14Janet HarrisonNaren Gunja15Gustavo Machado16Richard McNulty17Mark SalterPaul M Middleton18Ahilan Parameswaran19Kitty Duong20Andrew Coggins21Zoe Michaleff22Gemma Altinger23Trevor Chan24Karen Tambree25Ajay Varshney26Jeremy LawrenceKevin PileRichard CracknellKara GoonDaryn MitfordRaymond MorganJames MallowsKelly BivonaHelen ZaoukBrendon ShapterJim BasilakisHelen BadgeMichael MellerRobyn LinderDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, AustraliaDepartment of Obstetrics & Gynaecology, Royal Brisbane and Women`s Hospital, Brisbane, Queensland, AustraliaWhitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, AustraliaCentre for Clinical Informatics, Macquarie University, Sydney, New South Wales, AustraliaInstitute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia1 Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaMenzies Centre for Health Policy and Economics, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaCentre for Drug Evaluation, National Medical Products Administration, Beijing, People`s Republic of Chinaassociate professorCentre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, AustraliaEmergency and Trauma Centre, Royal Brisbane and Women`s Hospital, Brisbane, Queensland, AustraliaPediatrics, Yale University School of Medicine, New Haven, Connecticut, USAInstitute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, AustraliaLiverpool Hospital, Liverpool, New South Wales, AustraliaInformation Technology Services, Western Sydney Health, NSW, Australia and Sydney Medical School, University of Sydney, NSW, Australia1 Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaDepartment of Clinical and Experimental Medicine, University of Surrey, UKSouth Western Emergency Research Institute, Ingham Institute, Liverpool, New South Wales, Australia3Concord Hospital, New South Wales, Australia ahilan.parameswaran@sswahs.gov.auDepartment of Physiotherapy, Liverpool Hospital, Sydney, New South Wales, AustraliaDepartment of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, AustraliaEBP Professorial Unit, Gold Coast University Hospital, Southport, Queensland, Australia1University of Sydney, Sydney, Australia15 Emergency Care Institute, The Agency for Clinical Innovation, St Leonards Sydney, City of Willoughby, Australia16 Consumer Advisor, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia16 Consumer Advisor, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, AustraliaIntroduction Opioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different behavioural ‘nudge’ interventions on low-value care for ED patients with low back pain.Methods and analysis NUDG-ED is a 2×2 factorial, open-label, before-after, cluster randomised controlled trial. The trial includes 8 ED sites in Sydney, Australia. Participants will be ED clinicians who manage back pain, and patients who are 18 years or over presenting to ED with musculoskeletal back pain. EDs will be randomly assigned to receive (i) patient nudges, (ii) clinician nudges, (iii) both interventions or (iv) no nudge control. The primary outcome will be the proportion of encounters in ED for musculoskeletal back pain where a person received a non-indicated lumbar imaging test, an opioid at discharge or both. We will require 2416 encounters over a 9-month study period (3-month before period and 6-month after period) to detect an absolute difference of 10% in use of low-value care due to either nudge, with 80% power, alpha set at 0.05 and assuming an intra-class correlation coefficient of 0.10, and an intraperiod correlation of 0.09. Patient-reported outcome measures will be collected in a subsample of patients (n≥456) 1 week after their initial ED visit. To estimate effects, we will use a multilevel regression model, with a random effect for cluster and patient, a fixed effect indicating the group assignment of each cluster and a fixed effect of time.Ethics and dissemination This study has ethical approval from Southwestern Sydney Local Health District Human Research Ethics Committee (2023/ETH00472). We will disseminate the results of this trial via media, presenting at conferences and scientific publications.Trial registration number ACTRN12623001000695.https://bmjopen.bmj.com/content/14/3/e079870.full |
| spellingShingle | Rachelle Buchbinder Matthew Smith Ian A Harris Enrico Coiera Adrian C Traeger Chris G Maher Kirsten Howard Kirsten McCaffery Qiang Li Jeffrey A Linder James McAuley Louise Cullen Ian Ferguson Sweekriti Sharma Elise Tcharkhedian Janet Harrison Naren Gunja Gustavo Machado Richard McNulty Mark Salter Paul M Middleton Ahilan Parameswaran Kitty Duong Andrew Coggins Zoe Michaleff Gemma Altinger Trevor Chan Karen Tambree Ajay Varshney Jeremy Lawrence Kevin Pile Richard Cracknell Kara Goon Daryn Mitford Raymond Morgan James Mallows Kelly Bivona Helen Zaouk Brendon Shapter Jim Basilakis Helen Badge Michael Meller Robyn Linder Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial BMJ Open |
| title | Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial |
| title_full | Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial |
| title_fullStr | Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial |
| title_full_unstemmed | Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial |
| title_short | Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial |
| title_sort | behavioural nudging interventions to reduce low value care for low back pain in the emergency department nudg ed protocol for a 2 2 factorial before after cluster randomised trial |
| url | https://bmjopen.bmj.com/content/14/3/e079870.full |
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