Improving Antibiotic Prescribing for Pediatric Respiratory Infections by Family Physicians With Peer Comparison

NCT04588376 | Completed

• 1 other identifier: 1
• Study Type: interventional
• Target: 39
• Locations: 0 countries
• Sites: N/A

Brief Summary

Findings from an ongoing improvement project to improve antibiotic prescribing for children and adolescents for three acute respiratory tract infections (ARTIs: upper respiratory tract infection, acute bacterial sinusitis, and acute otitis media) among pediatric and family medicine clinics revealed performance gaps between the two primary care specialties. An improvement project was then set up to address the lower performance by family medicine clinics. Literature review revealed that, in general, quality improvement feedback was more effective if provided to individual clinicians rather than to a group of clinicians, but very limited data existed for antibiotic prescribing practices actually comparing individual clinician feedback to group (clinic-level) feedback. The hypothesis is that individual clinician data feedback is superior to group (clinic-level) feedback in improving antibiotic prescribing for ARTIs in children and adolescents by family medicine clinicians. The aim is to determine if there are significant differences for antibiotic prescribing for ARTIs and for broad spectrum antibiotic prescribing percentage between an intervention group and a comparator group of family medicine clinics after the intervention starting November 2015 and ending December 2018. A cluster randomized trial was designed for 39 family medicine clinics. The intervention group received clinician-level and clinic-level data feedback monthly, and the comparator group received clinic-level only feedback monthly.

Conditions

Upper Respiratory Infection; Acute Bacterial Sinusitis; Acute Otitis Media

Keywords

Peer Comparison; Feedback; Antibiotic Stewardship; Pediatric Acute Upper Respiratory Tract Infections

Outcome Measures

Primary Outcomes (3)

• Proportion of encounters with guideline-appropriate use of antibiotics for upper respiratory tract infection (URI or common cold) in participants 3 months - 18 years of age

  Measurement tool is electronic health record review of * Illness encounters in the time frame for diagnosis codes for URI or common cold * Antibiotics dispensed the day of the URI or common cold diagnosis encounter or 3 days subsequently * Antibiotics dispensed in the previous 30 days

  60 months, January 1, 2014 - October 31, 2015 (baseline period), November 1, 2015 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period)

• Proportion of encounters with guideline-appropriate use of antibiotics for acute bacterial sinusitis in participants 1 - 18 years of age

  Measurement tool is electronic health record review of * Illness encounters in the time frame for diagnosis codes for acute bacterial sinusitis * Antibiotics dispensed the day of the acute bacterial sinusitis diagnosis encounter or 3 days subsequently * Antibiotics dispensed in the previous 60 days

  60 months,January 1, 2014 - October 31, 2015 (baseline period), November 1 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period)

• Proportion of encounters with guideline-appropriate use of antibiotics for acute otitis media in participants 6 months - 12 years years of age

  Measurement tool is electronic health record review of * Illness encounters in the time frame for diagnosis codes for acute otitis media * Antibiotics dispensed the day of the acute otitis media diagnosis encounter or 3 days subsequently * Antibiotics dispensed in the previous 60 days

  60 months, January 1, 2014 - October 31, 2015 (baseline period), November 1, 2015 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period)

Secondary Outcomes (1)

• Mean baseline-to-intervention period change in broad-spectrum antibiotic prescribing percentage

  60 months, January 1, 2014 - October 31, 2015 (baseline period), November 1, 2015 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period)

Study Arms (2)

Clinician-level and clinic-level monthly feedback

EXPERIMENTAL

Group of 22 clinics to receive clinician-level and clinic-level monthly feedback on appropriate antibiotic use for three acute respiratory tract infections

Behavioral: Peer comparison feedback monthly

Clinic-level only monthly feedback

ACTIVE COMPARATOR

Group of 17 clinics to receive clinic-level only monthly feedback on appropriate antibiotic use for three acute respiratory tract infections

Behavioral: Peer comparison feedback monthly

Interventions

Peer comparison feedback monthly BEHAVIORAL

Monthly emailed data on performance for guideline-concordant use of antibiotics for three acute upper respiratory tract infections either at the clinician and clinic levels or at the clinic level only

Clinic-level only monthly feedback; Clinician-level and clinic-level monthly feedback

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Family Medicine clinic in Novant Health Medical Group with performance on the upper respiratory infection measure \< 85 per cent for the 6-month period, January- June 2015
• Email agreement to participate for the clinic by the lead clinician for the clinic.

You may not qualify if:

• Family Medicine clinic in Novant Health Medical Group with performance on the upper respiratory infection measure ≥ 83 per cent for the 6-month period, January - June 2015,
• \< 20 illness encounters for the upper respiratory infection measure recorded by the clinic for the 6-month period, January - June 2015,
• Email declination for the clinic by the lead clinician for the clinic

Sponsors & Collaborators

• Herb Clegg: lead

Related Publications (11)

• National Committee for Quality Assurance. Improving quality and patient experience. The State of Healthcare Quality 2013. October 2013, Washington, DC.

  BACKGROUND

• Hersh AL, Jackson MA, Hicks LA; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics. 2013 Dec;132(6):1146-54. doi: 10.1542/peds.2013-3260. Epub 2013 Nov 18.

  PMID: 24249823 BACKGROUND

• Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST; American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul;132(1):e262-80. doi: 10.1542/peds.2013-1071.

  PMID: 23796742 BACKGROUND

• Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, Joffe MD, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel DE. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99. doi: 10.1542/peds.2012-3488. Epub 2013 Feb 25.

  PMID: 23439909 BACKGROUND

• Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM Jr; Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012 Apr;54(8):e72-e112. doi: 10.1093/cid/cir1043. Epub 2012 Mar 20.

  PMID: 22438350 BACKGROUND

• The Pew Charitable Trust. Health experts establish national targets to improve outpatient antibiotic selection. https://www.pewtrusts.org/-/media/assets/2016/10/health_experts_establish_national_targets_to_improve_outpatient_antibiotic_selection.pdf.

  BACKGROUND

• Cohen, J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Routledge. ISBN 978-1-134-74270-7; 1988.

  BACKGROUND

• PASS 15 Power Analysis and Sample Size Software (2017). NCSS, LLC. Kaysville, Utah, USA, ncss.com/software/pass.

  BACKGROUND

• Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6(2):65-70.

  BACKGROUND

• Wu S, Crespi CM, Wong WK. Comparison of methods for estimating the intraclass correlation coefficient for binary responses in cancer prevention cluster randomized trials. Contemp Clin Trials. 2012 Sep;33(5):869-80. doi: 10.1016/j.cct.2012.05.004. Epub 2012 May 22.

  PMID: 22627076 BACKGROUND

• Clegg HW, Ezzo SJ, Flett KB, Anderson WE. Improving antibiotic prescribing for pediatric acute respiratory tract infections: A cluster randomized trial to evaluate individual versus clinic feedback. Antimicrob Steward Healthc Epidemiol. 2021 Nov 3;1(1):e43. doi: 10.1017/ash.2021.212. eCollection 2021.

  PMID: 36168454 DERIVED

MeSH Terms

Conditions

Respiratory Tract Infections; Otitis Media

Condition Hierarchy (Ancestors)

Infections; Respiratory Tract Diseases; Otitis; Ear Diseases; Otorhinolaryngologic Diseases

Study Officials

• Herbert W Clegg, MD

  Novant Health

  PRINCIPAL INVESTIGATOR

• Herbert W Clegg, MD

  Novant Health

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Senior Vice President, Clinical Excellence, Novant Health

Model Details: Parallel Cluster Randomized Trial

Study Record Dates

• First Submitted: September 30, 2020
• First Posted: October 19, 2020
• Study Start: August 1, 2015
• Primary Completion: December 31, 2018
• Study Completion: December 31, 2018
• Last Updated: October 19, 2020

Record last verified: 2020-10

Data Sharing

• IPD Sharing: Will not share