Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (Main Study)
BEARI
1 other identifier
interventional
248
1 country
55
Brief Summary
Bacteria resistant to antibiotic therapy are a major public health problem. The evolution of multi-drug resistant pathogens may be encouraged by provider prescribing behavior. Inappropriate use of antibiotics for nonbacterial infections and overuse of broad spectrum antibiotics can lead to the development of resistant strains. Though providers are adequately trained to know when antibiotics are and are not comparatively effective, this has not been sufficient to affect critical provider practices. The intent of this study is to apply behavioral economic theory to reduce the rate of antibiotic prescriptions for acute respiratory diagnoses for which guidelines do not call for antibiotics. Specifically targeted are infections that are likely to be viral. The objective of this study is to improve provider decisions around treatment of acute respiratory infections. The participants are practicing attending physicians or advanced practice nurses (i.e. providers) at participating clinics who see acute respiratory infection patients. A maximum of 550 participants will be recruited for this study. Providers consenting to participate will fill out a baseline questionnaire online. Subsequent to baseline data collection and enrollment, participating clinic sites will be randomized to the study arms, as described below. There will be a control arm, with clinic sites randomized in a multifactorial design to up to three interventions that leverage the electronic medical record: Order Sets that are triggered by electronic health record (EHR) workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives); Accountable Justifications triggered by discordant prescriptions that populate the note with provider's rationale for guideline exceptions (AJ); and performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparisons). The outcomes of interest are antibiotic prescribing patterns, including prescribing rates and changes in prescribing rates over time. The intervention period will be over one year, with a one-year follow up period to measure persistence of the effect after EHR features are returned to the original state and providers no longer receive email alerts.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Aug 2011
Typical duration for not_applicable
55 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
Study Start
First participant enrolled
August 1, 2011
CompletedFirst Submitted
Initial submission to the registry
August 4, 2011
CompletedFirst Posted
Study publicly available on registry
October 19, 2011
CompletedPrimary Completion
Last participant's last visit for primary outcome
April 1, 2014
CompletedStudy Completion
Last participant's last visit for all outcomes
September 1, 2014
CompletedResults Posted
Study results publicly available
June 20, 2017
CompletedMay 23, 2024
May 1, 2024
2.7 years
August 4, 2011
July 20, 2015
May 22, 2024
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Inappropriate Antibiotic Prescribing Rate for Qualifying Acute Respiratory Infection Diagnoses
Assess inappropriate antibiotic prescribing rates (relative to all practices that did not receive the intervention) for antibiotic-inappropriate acute respiratory tract infection visits and no concomitant reason for antibiotic prescribing. based on the following non-antibiotic-appropriate International Statistical Classification of Diseases, version 9 (ICD-9) diagnoses: 460 Acute nasopharyngitis (common cold) 465 Acute laryngopharyngitis/acute upper respiratory infection 466 Acute bronchitis 490 Bronchitis not specified as acute or chronic 487 Flu
18 months
Secondary Outcomes (1)
Encounters Closely Following the Index Encounter for Serious Diagnoses
18 months
Study Arms (8)
SA, AJ, PC
EXPERIMENTALParticipants are given all 3 interventions.
SA, AJ
EXPERIMENTALParticipants receive the Suggested Alternatives and Accountable Justification interventions, but not the Peer Comparison intervention.
SA, PC
EXPERIMENTALParticipants receive the Suggested Alternative and Peer Comparison interventions, but not the Accountable Justification intervention.
AJ, PC
EXPERIMENTALParticipants receive the Accountable Justification and Peer Comparison interventions, but not the Suggested Alternative intervention.
Peer Comparison (PC)
EXPERIMENTALParticipants receive the Peer Comparison intervention, but do not receive the Suggested Alternatives or Accountable Justification interventions.
Suggested Alternatives (SA)
EXPERIMENTALParticipants receive the Suggested Alternatives intervention, but not the Accountable Justification or Peer Comparison interventions.
Accountable Justification (AJ)
EXPERIMENTALParticipants receive the Accountable Justification intervention, but do not receive the Suggested Alternatives or Peer Comparison interventions.
Education Control
NO INTERVENTIONParticipants do not receive any of the 3 interventions.
Interventions
Accountable Justifications triggered by discordant prescriptions that populate the electronic health record (EHR) note with provider's rationale for guideline exceptions (AJ).
Performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison).
Order Sets that are triggered by EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives).
Eligibility Criteria
You may qualify if:
- A practicing attending physician or advanced practice nurse ("provider") at a participating clinic in 2011-2013 who sees acute respiratory infection patients.
You may not qualify if:
- None.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (55)
Altamed Anaheim Lincoln
Anaheim, California, 92801, United States
Altamed Anaheim West
Anaheim, California, 92801, United States
Altamed Bell Clinic
Bell, California, 90201, United States
Altamed Mobile Unit Primary Care
Commerce, California, 90040, United States
Altamed DVL El Monte
El Monte, California, 91731, United States
Altamed El Monte Clinic
El Monte, California, 91731, United States
Altamed Garden Grove Harbor
Garden Grove, California, 92840, United States
Altamed Huntington Beach Clinic
Huntington Beach, California, 92647, United States
Altamed PACE Rugby
Huntington Park, California, 90255, United States
The Children's Clinic Family Health Center at Cesar Chavez Elementary School
Long Beach, California, 90802, United States
The Children's Clinic Family Health Center at Hamilton Middle School
Long Beach, California, 90805, United States
The S. Mark Taper Foundation Children's Clinic Family Health Center
Long Beach, California, 90806, United States
The Children's Clinic at the Long Beach Multi-Service Center for the Homeless
Long Beach, California, 90813, United States
The Vasek Polak Children's Clinic Family Health Center
Long Beach, California, 90813, United States
Altamed PACE Grand Plaza
Los Angeles, California, 90012, United States
Altamed William Mead Homes
Los Angeles, California, 90012, United States
Altamed Commerce Clinic
Los Angeles, California, 90022, United States
Altamed DVL Commerce
Los Angeles, California, 90022, United States
Altamed PACE Pomona
Los Angeles, California, 90022, United States
Altamed Boyle Heights Clinic
Los Angeles, California, 90023, United States
Altamed Estrada Courts
Los Angeles, California, 90023, United States
Altamed Ramona Gardens
Los Angeles, California, 90023, United States
AltaMed 1st St Boyle Heights Clinic
Los Angeles, California, 90033, United States
Altamed Zonal Clinic
Los Angeles, California, 90033, United States
Altamed Montebello Clinic
Montebello, California, 90640, United States
Altamed El Modena Clinic
Orange, California, 92869, United States
Altamed Pico Clinic
Pico Rivera, California, 90060, United States
Altamed DVL Pico
Pico Rivera, California, 90660, United States
Altamed Santa Ana Main
Santa Ana, California, 92701, United States
Altamed Clinic For Women
Santa Ana, California, 92706, United States
Altamed Santa Ana Broadway
Santa Ana, California, 92707, United States
Altamed Santa Ana Central
Santa Ana, California, 92707, United States
Brigham and Women's Primary Care Associates at Foxborough
Boston, Massachusetts, 02035, United States
MGH Downtown
Boston, Massachusetts, 02108, United States
Mass General Medial Group
Boston, Massachusetts, 02114, United States
MGH Beacon Hill
Boston, Massachusetts, 02114, United States
MGH Senior Health
Boston, Massachusetts, 02114, United States
Women's Health Associates
Boston, Massachusetts, 02114, United States
Brigham Circle Medical Associates
Boston, Massachusetts, 02115, United States
Brigham Internal Medicine Associates
Boston, Massachusetts, 02115, United States
Spanish Clinic
Boston, Massachusetts, 02115, United States
MGH Back Bay
Boston, Massachusetts, 02228, United States
Brigham and Women's Primary Care Associates of Brookline
Brookline, Massachusetts, 02446, United States
MGH Charlestown HealthCare Center
Charlestown, Massachusetts, 02129, United States
MGH Chelsea HealthCare Center
Chelsea, Massachusetts, 02150, United States
Brigham and Women's Physician Group
Chestnut Hill, Massachusetts, 02467, United States
Gretchen and Edward Fish Center for Women's Health
Chestnut Hill, Massachusetts, 02467, United States
Everett Family Practice
Everett, Massachusetts, 02149, United States
Brigham Primary Physicians at Faulkner
Jamaica Plain, Massachusetts, 02130, United States
Brookside Community Health Center
Jamaica Plain, Massachusetts, 02130, United States
Faulkner Community Physicians
Jamaica Plain, Massachusetts, 02130, United States
Southern Jamaica Plain Health Center
Jamaica Plain, Massachusetts, 02130, United States
Brigham and Women's Primary Care Associates of Newton Corner
Newton, Massachusetts, 02458, United States
Mass General Revere HealthCare Center
Revere, Massachusetts, 02151, United States
Mass General West Medical Group
Waltham, Massachusetts, 02451, United States
Related Publications (5)
Meeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA. 2016 Feb 9;315(6):562-70. doi: 10.1001/jama.2016.0275.
PMID: 26864410BACKGROUNDDoctor JN, Goldstein NJ, Fox CR, Linder JA, Persell SD, Stewart EP, Knight TK, Meeker D. Clinician Job Satisfaction After Peer Comparison Feedback: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2317379. doi: 10.1001/jamanetworkopen.2023.17379.
PMID: 37289454DERIVEDGong CL, Zangwill KM, Hay JW, Meeker D, Doctor JN. Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis. J Gen Intern Med. 2019 Jun;34(6):846-854. doi: 10.1007/s11606-018-4467-x. Epub 2018 May 8.
PMID: 29740788DERIVEDGong CL, Hay JW, Meeker D, Doctor JN. Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment. BMJ Open. 2016 Sep 22;6(9):e012739. doi: 10.1136/bmjopen-2016-012739.
PMID: 27660322DERIVEDPersell SD, Friedberg MW, Meeker D, Linder JA, Fox CR, Goldstein NJ, Shah PD, Knight TK, Doctor JN. Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]--study protocol and baseline practice and provider characteristics. BMC Infect Dis. 2013 Jun 27;13:290. doi: 10.1186/1471-2334-13-290.
PMID: 23806017DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Results Point of Contact
- Title
- Jason N. Doctor
- Organization
- University of Southern California
Study Officials
- PRINCIPAL INVESTIGATOR
Jason N Doctor, PhD
University of Southern California
Publication Agreements
- PI is Sponsor Employee
- Yes
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- PARTICIPANT
- Purpose
- TREATMENT
- Intervention Model
- FACTORIAL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Associate Professor
Study Record Dates
First Submitted
August 4, 2011
First Posted
October 19, 2011
Study Start
August 1, 2011
Primary Completion
April 1, 2014
Study Completion
September 1, 2014
Last Updated
May 23, 2024
Results First Posted
June 20, 2017
Record last verified: 2024-05