Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (Main Study)

Completed · Not applicable

Conditions studied: Acute Respiratory Infections (ARIs)

In brief

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.

Key facts

Study ID

NCT01454947

Run by

University of Southern California

People needed

248

Starts

2011-08-01

Expected to finish

2014-09-01

Last updated by the study team

2024-05-23

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

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.

Where it is running

• Altamed Anaheim West — Anaheim, California, United States
• Altamed Bell Clinic — Bell, California, United States
• Altamed Mobile Unit Primary Care — Commerce, California, United States
• Altamed DVL El Monte — El Monte, California, United States
• Altamed El Monte Clinic — El Monte, California, United States
• Altamed Garden Grove Harbor — Garden Grove, California, United States
• Altamed Huntington Beach Clinic — Huntington Beach, California, United States
• Altamed PACE Rugby — Huntington Park, California, United States
• The Children's Clinic Family Health Center at Cesar Chavez Elementary School — Long Beach, California, United States
• The Children's Clinic Family Health Center at Hamilton Middle School — Long Beach, California, United States
• The S. Mark Taper Foundation Children's Clinic Family Health Center — Long Beach, California, United States
• The Children's Clinic at the Long Beach Multi-Service Center for the Homeless — Long Beach, California, United States
• The Vasek Polak Children's Clinic Family Health Center — Long Beach, California, United States
• Altamed PACE Grand Plaza — Los Angeles, California, United States
• Altamed William Mead Homes — Los Angeles, California, United States
• Altamed Commerce Clinic — Los Angeles, California, United States
• Altamed DVL Commerce — Los Angeles, California, United States
• Altamed PACE Pomona — Los Angeles, California, United States
• Altamed Boyle Heights Clinic — Los Angeles, California, United States
• Altamed Estrada Courts — Los Angeles, California, United States
• Altamed Ramona Gardens — Los Angeles, California, United States
• AltaMed 1st St Boyle Heights Clinic — Los Angeles, California, United States
• Altamed Zonal Clinic — Los Angeles, California, United States
• Altamed Montebello Clinic — Montebello, California, United States
• Altamed Anaheim Lincoln — Anaheim, California, United States

Full record on ClinicalTrials.gov

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