Use of a Behavioral Economic Intervention to Reduce Antibiotic Prescription for Upper Respiratory Infections

Sponsor

University of California, Los Angeles (Other)

Overall Status

Completed

CT.gov ID

NCT03464279

Collaborator

LAC+USC Medical Center (Other), Los Angeles County Department of Public Health (Other)

2,500

Enrollment

Location

Arms

Actual Duration (Months)

73.4

Patients Per Site Per Month

Study Details

Study Description

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.

Condition or Disease	Intervention/Treatment	Phase
Antibiotics Upper Respiratory Infections Safety-Net Hospitals Behavioral Economics Choosing Wisely	Behavioral: Nudge using Behavioral Economic Interventions Behavioral: Standard Practices to Reduce Health System Antibiotic Prescription	N/A

Detailed Description

National prescription rates for low-value antibiotics for uncomplicated upper respiratory infections (URIs) remain unacceptably high, including at LAC+USC Medical Center-one of the largest safety net medical centers in the U.S. 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 be compared. A three-part intervention at LAC+USC consists of (1) the urgent care medical director emailing Choosing Wisely® guidelines and presented journal club to all 16 urgent care clinicians, and then (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, which will be displayed in the clinic. In contrast, the control site (Urgent Care Center at Olive View-Medical Center) will receive Centers for Disease Control prescription pads for non-antibiotic treatments (e.g., decongestants) that offer patients alternatives to antibiotics, in a broader health system effort to reduce antibiotic prescribing. Patient with URIs (e.g., acute bronchitis, bronchitis NOS, excluding guideline-based red flags such as COPD, HIV) will be identified using electronic health record clinical billable data and low-value antibiotic prescriptions rates per visit will be monitored at both sites. Differences in prescriptions rates will be determined using an interrupted time-series analysis comparing utilization between sites using a repeated measures logistic regression model.

Study Design

Study Type:

Interventional

Actual Enrollment :

2500 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Masking:

Single (Participant)

Primary Purpose:

Health Services Research

Official Title:

Use of a Behavioral Economic Intervention to Reduce Antibiotic Prescription for Upper Respiratory Infections

Actual Study Start Date :

May 29, 2015

Actual Primary Completion Date :

Mar 30, 2018

Actual Study Completion Date :

Mar 30, 2018

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Intervention Site 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
Active Comparator: Control Site 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

Arm

Intervention/Treatment

Experimental: Intervention Site

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

Active Comparator: Control Site

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

Outcome Measures

Primary Outcome Measures

Change in Low-value antibiotic prescriptions rates per visit [1 year]
Changes in inappropriate antibiotic prescriptions rates per visit before and after implementation of intervention at both sites

Secondary Outcome Measures

Coding Shift (ie, a shift in use of diagnostic codes to conditions that are more antibiotic appropriate) in URI diagnosis [1 year]
Change frequency of proportion of antibiotic appropriate diagnoses before intervention and after at both sites.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

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

Exclusion Criteria:

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

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Los Angeles County +University of Southern California (LAC+USC) Medical Center	Los Angeles	California	United States	90033

Sponsors and Collaborators

University of California, Los Angeles
LAC+USC Medical Center
Los Angeles County Department of Public Health

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

Responsible Party:

Catherine A. Sarkisian, Professor in Residence, University of California, Los Angeles

ClinicalTrials.gov Identifier:

NCT03464279

Other Study ID Numbers:

IRB #16-000932-004

First Posted:

Mar 14, 2018

Last Update Posted:

May 2, 2018

Last Verified:

Apr 1, 2018

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Additional relevant MeSH terms:

Infections

Communicable Diseases

Respiratory Tract Infections

Anti-Bacterial Agents

Study Results

No Results Posted as of May 2, 2018