Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (Pilot Study)
BEARI
2 other identifiers
interventional
28
1 country
1
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 EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives); Accountable Justification (AJ) triggered by discordant prescriptions that populate the note with provider's rationale for guideline exceptions ; and performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison). 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 below P25 for not_applicable
Started Jul 2011
Typical duration for not_applicable
1 active site
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
July 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
February 1, 2013
CompletedStudy Completion
Last participant's last visit for all outcomes
September 1, 2014
CompletedApril 4, 2017
March 1, 2017
1.6 years
August 4, 2011
March 31, 2017
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Antibiotic Prescribing Rate for 5 Specific Acute Respiratory Infection Diagnoses
Changes in antibiotic prescribing rate for the following ICD-9 diagnoses: 460 Acute nasopharyngitis (common cold) 465 Acute laryngeopharyngitis/acute upper respiratory infection 466 Acute bronchitis 490 Bronchitis not specified as acute or chronic 487 Flu
2 years
Secondary Outcomes (1)
Antibiotic Prescribing Rates for Expanded List of Acute Respiratory Infection Diagnoses
2 years
Study Arms (8)
SA, AJ, PC
EXPERIMENTALParticipants are given all 3 interventions: Suggested Alternatives, Accountable Justification, and Peer Comparison.
SA, AJ
EXPERIMENTALParticipants receive the Suggested Alternatives and Accountable Justification interventions, but not the Peer Comparison intervention.
SA, PC
EXPERIMENTALParticipants receive the Suggested Alternatives 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 Alternatives intervention.
Peer Comparison
EXPERIMENTALParticipants receive the Peer Comparison intervention, but do not receive the Suggested Alternatives or Accountable Justification interventions.
Suggested Alternatives
EXPERIMENTALParticipants receive the Suggested Alternatives intervention, but not the Accountable Justification or Peer Comparison interventions.
Accountable Justification
EXPERIMENTALParticipants receive the Accountable Justification intervention, but do not receive the Suggested Alternatives or Peer Comparison interventions.
Control
NO INTERVENTIONParticipants do not receive any of the 3 interventions.
Interventions
Accountable Justification is triggered by discordant prescriptions that populate the 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 Northwestern University's NMFF GIM Clinic in 2011-2013 who sees acute respiratory infection patients.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Northwestern Medical Faculty Foundation General Internal Medicine Clinic
Chicago, Illinois, 60611-2923, United States
Related Publications (1)
Persell SD, Doctor JN, Friedberg MW, Meeker D, Friesema E, Cooper A, Haryani A, Gregory DL, Fox CR, Goldstein NJ, Linder JA. Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial. BMC Infect Dis. 2016 Aug 5;16:373. doi: 10.1186/s12879-016-1715-8.
PMID: 27495917DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Stephen Persell, MD
Northwestern University
- STUDY DIRECTOR
Jason N Doctor, PhD
University of Southern California
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
July 1, 2011
Primary Completion
February 1, 2013
Study Completion
September 1, 2014
Last Updated
April 4, 2017
Record last verified: 2017-03