RCT to Improve Antibiotic Use for ARIs
Study Details
Study Description
Brief Summary
Many clinicians prescribe antibiotics for patients with acute respiratory infections even when antibiotics will not benefit the patient because the infection is due to a virus. To discourage this type of unnecessary antibiotic use, we will assess whether it is helpful to give clinicians feedback on how often they prescribe antibiotics for respiratory infections in comparison to their peers. We will perform this study across Urgent Care and QuickCare clinics within a single healthcare system.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
We have used an established HEDIS (Healthcare Effectiveness Data and Information Set) metric to evaluate Urgent Care and QuickCare clinicians on their antibiotic use for respiratory tract diagnoses (RTDs). This RTD metric excludes visits that are more complicated, based on well-defined criteria. Based on our baseline assessment (2018-2022), we estimate that most clinicians in this setting are frequently prescribing unnecessary antibiotics.
We will perform a randomized controlled trial to assess whether providing individualized feedback to clinicians on the RTD metric can safely reduce antibiotic use for qualifying respiratory tract visits across Urgent and QuickCare settings within a single integrated healthcare system. Clinicians who do not opt-out of the trial will be randomized to either receive feedback or not receive feedback on this RTD metric. The trial will last for 18 months. The primary outcome of effectiveness will be the frequency of antibiotic-prescribing for RTD visits. Secondary outcomes include total antibiotic use (regardless of diagnosis), changes in the use of diagnostic codes, 30-day rates of follow-up visits and hospital admissions. The RE-AIM framework will be used to guide additional study evaluation.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Feedback on RTD metric An e-mail will be sent to the clinicians in the experimental arm every two months describing their performance on the RTD metric and making a comparison to how their peers have performed. The e-mail will also direct clinicians to visit a dashboard to review their practice in greater depth. |
Behavioral: Feedback on RTD metric
Clinicians in the experimental arm will receive feedback on the RTD metric while clinicians in the No intervention arm will not.
|
| No Intervention: No feedback on RTD metric Any clinician assigned to the control arm will not receive the above-mentioned e-mails. |
Outcome Measures
Primary Outcome Measures
- Frequency of antibiotic-prescribing for RTD visits [24 hours of visit]
Percentage of all qualifying respiratory tract diagnosis (RTD) visits prescribed an antibiotic
Secondary Outcome Measures
- Frequency of antibiotic-prescribing for all visits [24 hours of visit]
Percentage of all visits prescribed an antibiotic, regardless of the diagnosis
- Follow-up visit to Urgent Care or QuickCare [30 days]
Percentage of patients with a qualifying RTD visit who were seen at least once in Urgent Care or QuickCare within the 30 days after their index visit date.
- Follow-up Emergency Department visit and/or acute-care hospitalization [30 days]
Percentage of patients with a qualifying RTD visit who were seen at least once in the Emergency Department and/or who were hospitalized (any reason) within the 30 days after their index visit date.
Eligibility Criteria
Criteria
Any clinician who works in Urgent Care or QuickCare clinics within our healthcare system.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Daniel Livorsi
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 202308456