Reducing Low-Value Care: Applying the Intention-Action Framework to Specialty Referrals
University of California, Los Angeles
Summary
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.
Description
Low-value care-services that provide little or no clinical benefit-is a significant problem in the United States. For example, low-value specialty referrals often lead to unnecessary tests, follow-ups, and procedures that burden patients, weaken trust, and reduce access to specialty care for those with greater clinical need. This study is a six-month, single-site, randomized controlled trial conducted at UCLA Health to evaluate an electronic health record (EHR)-embedded behavioral intervention designed to reduce low-value specialty referrals in cardiology, pulmonology, and gastroenterology. T…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * 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 Exclusion Criteria: * Physicians who are no longer actively practicing at UCLA Health as of July 1, 2026
Interventions
- BehavioralInformation provision
The order composer displays high-value criteria developed by UCLA Health using professional society guidelines and expert consensus from clinical leadership.
- BehavioralAuditing
The order composer notifies physicians that their referral decisions may be subject to review.
- BehavioralChecklist
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.
Location
- UCLA Health Department of MedicineLos Angeles, California