A Multicenter Cluster Randomized Controlled Trial of Strategies to Improve Thyroid Function Testing

Abstract

Using a robust design, our study shows the greater effectiveness of TRF than MPC and their association in implementing thyroid function test guidelines.

Review: What Can We Learn From Quality Improvement Research?

“…As opposed to most RCTs, in which patients are randomized, this study randomized hospitals to the control and intervention groups, thereby allowing the researchers to control for confounding factors associated with hospital type. Likewise, a study by Daucourt, Saillour-glenisson, Michel, Jutand, and Abouelfath (2003) examined the effectiveness of two different types of thyroid function guidelines. This study examined the effectiveness of these guidelines in small, midsize, and psychiatric hospitals, as well as across different types of units within these hospitals (e.g., general medicine, emergency room, and psychiatry).…”

Nudge strategies to improve healthcare providers’ implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews

“…The most commonly used nudge strategy was priming, which was included in 69% (n = 29) of trials, across 41 outcomes. The impact of this nudge strategy was assessed on a range of implementation outcomes including adherence to antibiotic prescribing guidelines [104,105,123], prescribing rates of medication and test ordering of various conditions [27,92,93,98,99,103,106,118,119,121,129,131], vaccinations [94], provision of care according to guidelines [90,91,96,100,103,124,126], and adherence to hand hygiene guidelines [95,97,101,102,107,122,130]. Priming nudges were also applied in various clinical settings including hospitals [95,102,104,118,122,130], primary care practices [27, 91, 93, 94, 96, 99-101, 103, 119, 121, 124], mental health units [106] and community-based long-term care facilities [107].…”

“…The one study that used a commitment/ego nudge was conducted in hospitals to increase adherence to hand hygiene where clinicians publicly declared their commitment to either reduce inappropriate behaviour or increase recommended behaviour [130]. A default nudge was used in one study conducted in hospitals where test ordering options related to thyroid function not relevant to patients were shaded out based on ordering forms and incentive strategies [118]. The incentive strategy primarily included provision of certificates and professional…”

Things We Do for No Reason™: Routine Thyroid-Stimulating Hormone Testing in the Hospital

“…Several institutions have implemented quality improvement (QI) initiatives to reduce inappropriate thyroid function testing without apparent compromise to clinical care 14 . Although none included balancing measures within their QI design, the implementation of simple appropriateness guidelines, for example, has been shown to reduce the frequency of TSH ordering by as much as 50%, which suggests significant overtesting 5,15,16 . Similarly, in a clustered randomized control trial, Thomas et al demonstrated a significant reduction (odds ratio [OR] 0.82) in outpatient TSH ordering after the addition of a simple educational message to the order 17 …”