Applying the Intention-Action Framework to Specialty Referrals

ConditionsCardiology Gastroenterology Pulmonology

Trial statusNot yet recruiting

Trial phaseNot applicable

Trial typeInterventional

Biological sexAll

Age18+

SponsorUniversity of California, Los Angeles

About this trial

This is a prospective randomized controlled trial evaluating an EHR-embedded behavioral intervention intended to reduce low-value specialty referrals in cardiology, pulmonology, and gastroenterology. The intervention is designed to (1) strengthen physicians' intentions to avoid low-value specialty referrals at the point of encounter by presenting criteria for high-value referrals and informing physicians that referral decisions may be reviewed and (2) support follow-through on these intentions by modifying the referral process through structured checklist prompts embedded within the referral workflow.

The primary hypothesis is that physicians exposed to the intervention will demonstrate lower rates of low-value cardiology, pulmonology, and gastroenterology referrals compared with physicians exposed to the arm where the order composer allows physicians to place referrals with minimal decision support.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

UCLA Health physicians who have made at least one specialty referral to cardiology, pulmonology, or gastroenterology for patients in UCLA Health primary care registry during July-December 2025

Disqualifiers

Physicians who are no longer actively practicing at UCLA Health as of July 1, 2026

Trial design

Design model

Parallel

Treatments tested in this trial

Information provision
Behavioral
The order composer displays high-value criteria developed by UCLA Health using professional society guidelines and expert consensus from clinical leadership.
Auditing
Behavioral
The order composer notifies physicians that their referral decisions may be subject to review.
Checklist
Behavioral
The order composer includes cascading checkboxes that prompt physicians to confirm that referral criteria are met before submitting a referral. Physicians must actively indicate whether the patient meets referral criteria before submitting a referral. Physicians who determine that a referral remains clinically appropriate despite the patient not meeting listed criteria may select an option indicating that none of the listed criteria apply and provide a brief free-text explanation for proceeding with the referral.

Treatment groups

1,600 Participants

are divided into 3 treatment groups

Group A: Arm 1: ControlNo intervention 0 interventions

Group B: Arm 2: Information + ReviewExperimental treatment 2 interventions

Group C: Arm 3: Information + Review + ChecklistExperimental treatment 3 interventions

Trial outcomes

Primary outcomes

Physician-level rate of low-value specialty referrals per 100 referral relevant encounters

A low-value referral is defined as a referral to one of the three target specialty divisions placed during a referral-relevant encounter that does not meet the pre-specified referral criteria developed by UCLA Health division chiefs for the corresponding medical condition. The primary outcome is calculated as the number of low-value referrals divided by the number of referral-relevant encounters, multiplied by 100, aggregated at the physician level.

Time frame