NCT03464279

Brief Summary

In an effort to implement Choosing Wisely guidelines and decrease patient harm, we will implement and evaluate a clinician audit-feedback and behavioral "nudge" initiative to reduce low-value antibiotics for URIs. Using a quasi-experiment (pre-post) design, antibiotic prescriptions for URI at LAC+USC Urgent Care Center (intervention site) vs. Olive View-UCLA Urgent Care Center (control site) will used to test the effects of behavioral "nudge" on antibiotic prescribing.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
2,500

participants targeted

Target at P75+ for not_applicable

Timeline
Completed

Started May 2015

Typical duration for not_applicable

Geographic Reach
1 country

1 active site

Status
completed

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

May 29, 2015

Completed
2.8 years until next milestone

First Submitted

Initial submission to the registry

March 7, 2018

Completed
7 days until next milestone

First Posted

Study publicly available on registry

March 14, 2018

Completed
16 days until next milestone

Primary Completion

Last participant's last visit for primary outcome

March 30, 2018

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

March 30, 2018

Completed
Last Updated

May 2, 2018

Status Verified

April 1, 2018

Enrollment Period

2.8 years

First QC Date

March 7, 2018

Last Update Submit

April 30, 2018

Conditions

AntibioticsUpper Respiratory InfectionsSafety-Net HospitalsBehavioral EconomicsChoosing Wisely

Outcome Measures

Primary Outcomes (1)

  • Change in Low-value antibiotic prescriptions rates per visit

    Changes in inappropriate antibiotic prescriptions rates per visit before and after implementation of intervention at both sites

    1 year

Secondary Outcomes (1)

  • Coding Shift (ie, a shift in use of diagnostic codes to conditions that are more antibiotic appropriate) in URI diagnosis

    1 year

Study Arms (2)

Intervention Site

EXPERIMENTAL

The intervention Site (Urgent Care Center at LAC+USC Medical Center) will receive a three part intervention consisting of (1) Email Choosing Wisely® guidelines and presented journal club to all 16 urgent care clinicians, (2) leveraging EHR performance data to provide individual clinicians with case-specific audit-feedback (both via emails and in-person while precepting nurse practitioners) on low-value antibiotic prescribing, and (3) using a behavioral "nudge", urgent care clinicians will sign a large poster committing to avoid prescribing low-value antibiotics for uncomplicated URIs displayed in the clinic.

Behavioral: Nudge using Behavioral Economic Interventions

Control Site

ACTIVE COMPARATOR

The control site (Urgent Care Center at Olive View-Medical Center) will receive broader health system efforts to reduce antibiotic prescribing consisting of Center for Disease Control prescription pads for non-antibiotic treatments (e.g., decongestants) that offer patients alternatives to antibiotics.

Behavioral: Standard Practices to Reduce Health System Antibiotic Prescription

Interventions

Nudge using Behavioral Economic InterventionsBEHAVIORAL
Intervention Site
Standard Practices to Reduce Health System Antibiotic PrescriptionBEHAVIORAL
Control Site

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersYes
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • all patient receiving treatment for Upper Respiratory Infections (defined by ICD codes EHR billable codes) at both LAC+USC Medical Center Urgent Care or Olive View-UCLA Medical Center

You may not qualify if:

  • Patients not receiving treatment for Upper Respiratory Infections at both LAC+USC Medical Center Urgent Care or Olive View-UCLA Medical Center

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Los Angeles County +University of Southern California (LAC+USC) Medical Center

Los Angeles, California, 90033, United States

Location

Related Publications (2)

  • Meeker D, Knight TK, Friedberg MW, Linder JA, Goldstein NJ, Fox CR, Rothfeld A, Diaz G, Doctor JN. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial. JAMA Intern Med. 2014 Mar;174(3):425-31. doi: 10.1001/jamainternmed.2013.14191.

    PMID: 24474434BACKGROUND

  • Gonzales R, Steiner JF, Lum A, Barrett PH Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999 Apr 28;281(16):1512-9. doi: 10.1001/jama.281.16.1512.

    PMID: 10227321BACKGROUND

MeSH Terms

Conditions

Respiratory Tract Infections

Condition Hierarchy (Ancestors)

InfectionsRespiratory Tract Diseases

Study Design

Study Type
interventional
Phase
not applicable
Allocation
NON RANDOMIZED
Masking
SINGLE
Who Masked
PARTICIPANT
Purpose
HEALTH SERVICES RESEARCH
Intervention Model
PARALLEL
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Professor in Residence

Study Record Dates

First Submitted

March 7, 2018

First Posted

March 14, 2018

Study Start

May 29, 2015

Primary Completion

March 30, 2018

Study Completion

March 30, 2018

Last Updated

May 2, 2018

Record last verified: 2018-04

Locations

US(1)