Peer Comparison Feedback As An Antimicrobial Prescribing Intervention To General Medicine Specialists

NCT07189364 | Enrolling By Invitation

• 1 other identifier: 5327
• Study Type: interventional
• Target: 650
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to evaluate the effect of a peer comparison feedback report, combined with a best practices toolkit, on the volume of antimicrobial use by general medicine physicians. The study also aims to understand the qualitative and quantitative impact of peer comparison feedback on antimicrobial prescribing in hospital. This study will leverage data from GEMINI, a hospital research collaborative that collects administrative and clinical data from 30+ Ontario hospitals, to create these peer comparison feedback reports.

Conditions

Antimicrobial Stewardship; Antimicrobial Drug Resistance

Keywords

Antimicrobial Stewardship; Antimicrobial Resistance; Audit and feedback

Outcome Measures

Primary Outcomes (1)

• Antimicrobial Days of Therapy (DOT)/100 days present

  The primary trial outcome will be aggregate DOT (Days of Therapy)/100 days present, at the physician level. DOT are defined by the sum of days treated with each antimicrobial agent (e.g., 2 agents each day over 2 days is 4 DOT/days present). Days present are defined by the number of days between hospital admission and discharge attributed to each physician. Partial days are considered days present based upon the percentage of the day in hospital calculated by hour of admission and discharge. This highly relevant outcome captures many axes of use including initiation and discontinuation decisions.

  The primary outcome will be measured for 24 month prior to intervention delivery (i.e., the baseline period) and for 12 months after intervention delivery (i.e., the follow-up period).

Secondary Outcomes (11)

• Initiation of antimicrobial therapy

  All secondary outcomes will be measured for 24 month prior to intervention delivery (i.e., the baseline period) and for 12 months after intervention delivery (i.e., the follow-up period).

• Discontinuation of antimicrobial therapy within 72 hours

  All secondary outcomes will be measured for 24 month prior to intervention delivery (i.e., the baseline period) and for 12 months after intervention delivery (i.e., the follow-up period).

• Antimicrobial-free days

  All secondary outcomes will be measured for 24 month prior to intervention delivery (i.e., the baseline period) and for 12 months after intervention delivery (i.e., the follow-up period).

• Antimicrobial choice

  All secondary outcomes will be measured for 24 month prior to intervention delivery (i.e., the baseline period) and for 12 months after intervention delivery (i.e., the follow-up period).

• Mechanism of action (interview)

  This process evaluation outcome will be measured within 12 months of the intervention delivery (i.e., during the follow-up period).

Study Arms (2)

Intervention Group

EXPERIMENTAL

The intervention group will receive an electronic peer-comparison feedback report on their antimicrobial prescribing practices and a knowledge toolkit about antimicrobial use, bundled as a single intervention.

Behavioral: Peer Comparison Feedback Report

Control Group

NO INTERVENTION

The control group will not receive a peer-comparison feedback report on their antimicrobial prescribing practices, or a knowledge toolkit on antimicrobial use.

Interventions

Peer Comparison Feedback Report BEHAVIORAL

The intervention will be an electronic, individualized, peer-comparison feedback report on the participant's antimicrobial prescribing practices, combined with a knowledge toolkit focused on optimizing antimicrobial use.

Intervention Group

Eligibility Criteria

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

You may qualify if:

• Patient-level: All adult inpatients (\>=18 years of age) discharged within the baseline evaluation period and follow up period will be included in a physician report if they match the following criteria: a) Total in-hospital length of stay (LOS) is less than or equal to 14 days; b) and admitted to or discharged from a general medicine or hospitalist ward; c) admitted via the emergency department.
• Physician-level: Physicians will be included if they have at least 50 hospitalizations attributed to them during the baseline period. Physicians who practice at multiple sites will only be included at the hospital with more encounters.
• Hospital-level: In total, 29 teaching and community hospitals that provide data to GEMINI, with comprehensive geographic coverage of Ontario, will be included in this trial.

You may not qualify if:

• Patient-level: All data from ICU dates of care will be excluded from the trial (defined by ICU admission start and stop dates). All antimicrobial use data from ICU dates will be censored and excluded from attribution to GM physicians. Additionally, all patients with ICD-10-CA code Z51.5 for palliative care will be excluded owing to expected differences in antimicrobial management strategies.
• Hospital-level: Two hospitals in the GEMINI network will be excluded from this trial due to their lack of GM wards (a cancer hospital and a COVID-19 reactivation hospital). Additionally, any hospitals in the GEMINI network that do not meet annual data quality standards for antimicrobial use or other data fields will not be included in the trial.

Sponsors & Collaborators

• Fahad Razak: lead
• Canadian Institutes of Health Research (CIHR): collaborator
• Sinai Health System: collaborator
• Unity Health Toronto: collaborator

Study Sites (1)

GEMINI Research Program

Toronto, Ontario, M5B 1T8, Canada

Location

Study Officials

• Fahad Razak, MD

  St. Michael's Hospital - Unity Health Toronto

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: MD, St. Michael's Hospital - Unity Health Toronto

Study Record Dates

• First Submitted: August 26, 2025
• First Posted: September 23, 2025
• Study Start: September 1, 2025
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): April 1, 2027
• Last Updated: May 5, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will share
• Time Frame: Beginning in September 2025, with no end date.
• Access Criteria: GEMINI data can be accessed through GEMINI's secure research environment, once approved by GEMINI's Projects \& Publications Committee and the appropriate REB Office. To access data, researchers must submit a project proposal to GEMINI.Research@unityhealth.to, using the standardized template available here: https://geminimedicine.ca/access-gemini-data/

Locations

CA (1)