An interventional study of Peer Comparison Feedback and Patient Informational Letter in Surgery and Aging, sponsored by University of Pennsylvania. Completed at 1 site in United States. Open to participants aged 65 Years and older. Per ClinicalTrials.gov, last updated 2024-01-18.
Sponsored by University of Pennsylvania · Not applicable, Interventional, and Health services research
Over 21 million surgical procedures take place among adults aged 65 and older in the US each year, and most older surgical patients in the US now receive benzodiazepines (e.g., midazolam, lorazepam) during anesthesia care. This occurs despite recommendations to avoid these medications in older patients due to associated medical risks and lack of demonstrated benefit. In other words, routine benzodiazepine administration to older surgical patients is likely to represent low-value care that is a suitable target for de-adoption. In this study, we will evaluate a United States Anesthesia Partners (USAP, Dallas, TX) quality improvement initiative using peer comparison feedback to clinicians and/or mailed informational letters to patients as strategies to encourage physician de-adoption of routine preoperative benzodiazepine administration to older surgical patients. In partnership with USAP, this study will be conducted using randomization to evaluate its effect.
University of Pennsylvania is the lead sponsor of 1,635 studies on the registry; 239 are open to participants now.
Of its 154 completed or terminated interventional studies of FDA-regulated products, 104 (68%) have results posted.
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Exclusion Criteria:
Behavioral: Peer Comparison Feedback
Behavioral: Patient Informational Letter
Behavioral: Peer Comparison Feedback · Behavioral: Patient Informational Letter
USAP anesthesia providers will receive monthly alerts via USAP's smartphone-based practice management application, text message, or email presenting individual-level data on their benzodiazepine administration patterns versus other USAP providers, using data from the USAP clinical and quality data warehouse.
Breif informational letters will be distributed to eligible patients within the 2 weeks prior to surgery. Letters will be produced on USAP letterhead and signed by the USAP Chief Quality Officer. Letter text will state USAP's commitment to brain health and avoiding potentially unnecessary medications for patients undergoing surgery. It will also include a statement encouraging patients to discuss anesthesia plans with their clinicians at the time of surgery to aid tailoring of care to individual needs. Letters will be distributed directly to patients via text link, email, or hard copy as a component of standard pre-operative instructional communications and other educational and patient outreach materials related to clinical care.
Benzodiazepine administration rate
The primary outcome measure is the change in the rate of benzodiazepine administration among eligible surgical cases.
Time frame: Intraoperative period
Patient satisfaction
Change in patient satisfaction with care, as measured by Anesthesiologist Patient Satisfaction Questionnaire Composite Satisfaction Score, Version 2 (APSQ2).
Time frame: Up to 30 days after surgery
Hospital length of stay
Time from surgery to hospital discharge in days
Time frame: Length of stay will be evaluated at approximately 30 days after surgery
Postoperative pulmonary complications
Postoperative pulmonary complications as identified by ICD-10 codes for patients undergoing hospitalization after surgery
Time frame: Up to 30 days after surgery
Postoperative Delirium
Postoperative delirium as identified by ICD-10 codes for patients undergoing hospitalization after surgery
Time frame: Up to 30 days after surgery
Plan to share: No
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This study is completed, as verified in Jan 2024. You cannot join it, but the record below documents what was studied.
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