TY - JOUR
T1 - Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDGED): protocol for a 2×2 factorial, before-after, cluster randomised trial
AU - NUDG-ED Study Group
AU - Altinger, Gemma
AU - Sharma, Sweekriti
AU - Maher, Chris G.
AU - Cullen, Louise
AU - McCaffery, Kirsten
AU - Linder, Jeffrey A.
AU - Buchbinder, Rachelle
AU - Harris, Ian A.
AU - Coiera, Enrico
AU - Li, Qiang
AU - Howard, Kirsten
AU - Coggins, Andrew
AU - Middleton, Paul M.
AU - Gunja, Naren
AU - Ferguson, Ian
AU - Chan, Trevor
AU - Tambree, Karen
AU - Varshney, Ajay
AU - Traeger, Adrian C.
AU - Lawrence, Jeremy
AU - Pile, Kevin
AU - Cracknell, Richard
AU - Hermiz, Arsalan
AU - Moncada, Francisco
AU - Mitford, Daryn
AU - Salter, Mark
AU - Mallows, James
AU - Morgan, Raymond
AU - Hastings, Cindy
AU - McNulty, Richard
AU - Frost, Alexandra
AU - Burns, Belinda
AU - Bivona, Kelly
AU - Fenech, Jordan
AU - Zaouk, Helen
AU - Smith, Matthew
AU - Parameswaran, Ahilan
AU - Morris, Jenny
AU - Shapter, Brendon
AU - Van Vorst, Daniel
AU - Squire, Peter
AU - Basilakis, Jim
AU - Meller, Michael
AU - Tcharkhedian, Elise
AU - Machado, Gustavo
AU - McAuley, James
AU - Harrison, Janet
AU - Michaleff, Zoe
AU - van Wyk, Aidan
AU - McKeown, Wade
AU - Davis, Jo
AU - Ho, Eric
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024.
PY - 2024/3/28
Y1 - 2024/3/28
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85189272041&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2023-079870
DO - 10.1136/bmjopen-2023-079870
M3 - Article
C2 - 38548366
AN - SCOPUS:85189272041
SN - 2044-6055
VL - 14
SP - 1
EP - 12
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e079870
ER -