TY - JOUR
T1 - Behavioural 'nudging' interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED)
T2 - protocol for a 2×2 factorial, before-after, cluster randomised trial
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 - NUDG-ED Study Group
N1 - Copyright the Author(s) 2024. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
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.Trial registration number: ACTRN12623001000695.
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.Trial registration number: ACTRN12623001000695.
KW - Humans
KW - Analgesics, Opioid/therapeutic use
KW - Australia
KW - Emergency Service, Hospital
KW - Low Back Pain/therapy
KW - Low-Value Care
KW - Musculoskeletal Pain
KW - Randomized Controlled Trials as Topic
KW - Young Adult
KW - Adult
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
SN - 2044-6055
VL - 14
SP - 1
EP - 12
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e079870
ER -