Non-Inferiority of Peer Comparison Interventions
Study Details
Study Description
Brief Summary
The objective of this study is to test the hypothesis that the Peer Comparison intervention in the Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (BEARI) trial (Meeker et al. 2016) promoting antibiotic stewardship did not adversely impact physician job satisfaction as measured in the study exit survey at trial completion. Detrimental impacts on job satisfaction is a phenomenon that was observed in a randomized controlled trial using a Peer Comparison intervention with different characteristics from the BEARI trial. (Reiff et al. 2022) The BEARI trial sample size, intraclass correlation, and measurement of job satisfaction are comparable to Reiff et al. 2022.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
This secondary analysis includes all providers from the Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (BEARI) trial who completed the exit survey following 18 month trial completion. The objective of this study is to test the hypothesis that the Peer Comparison intervention in the BEARI trial (Meeker et al. 2016) promoting antibiotic stewardship did not adversely impact physician job satisfaction. Detrimental impacts on job satisfaction is a phenomenon that was observed in a randomized controlled trial using a Peer Comparison intervention with different characteristics from the BEARI trial. (Reiff et al. 2022) The BEARI trial sample size, intraclass correlation, and measurement of job satisfaction are comparable to Reiff et al. 2022.
The differences in Peer Comparison interventions between BEARI and Reiff et al. include the following:
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Differences in physicians' control and agency over patient adherence to screening recommendations vs. their own antibiotic prescribing
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Relatedly, in the antibiotic stewardship study, there were achievable benchmarks for improvement, including a feedback and ranking framework allowing all physicians to attain the highest status and thus obtain positive feedback.
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Differences in framing and presentation of messages
The investigators define a clinically significant detrimental effect on job satisfaction as 27% of individuals reducing job satisfaction ratings by one point on a 5-point likert scale. This shift is equivalent to a mean difference of 0.32 and a Cohen's d of 0.36. This difference corresponds to approximately a ⅓ reduction in job satisfaction on a 5-point likert scale.
H0: The BEARI Peer Comparison intervention had a clinically and statistically significant detrimental effect on physician job satisfaction. Control-PeerComparison>=0.32
HA: The Peer Comparison intervention had no clinically significant negative impact on physician job satisfaction. Control-PeerComparison<0.32
The investigators will conduct a traditional hypothesis test Control-PeerComparison= 0.0 as a secondary analysis.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Peer Comparison Providers from the BEARI trial who received the Peer Comparison intervention. |
Behavioral: Peer Comparison
Peer comparison was an email-based intervention. Clinicians were ranked from highest to lowest inappropriate prescribing rate within each region using EHR data. Clinicians with the lowest inappropriate prescribing rates (the top-performing decile) were told via monthly email they were "Top Performers". The remaining clinicians were told that they were "Not a Top Performer" in an email that included the number and proportion of antibiotic prescriptions they wrote for antibiotic-inappropriate acute respiratory tract infections, compared with the proportion written by top performers.
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| Control Providers from the BEARI trial who did not receive the Peer Comparison intervention. |
Outcome Measures
Primary Outcome Measures
- Job satisfaction [18 months]
Impact of BEARI Peer Comparison intervention on Job Satisfaction, as measured by the following question completed as part of the BEARI trial exit survey: "Please indicate how much you agree or disagree with the following statement. Overall, I am satisfied with my current job."
Eligibility Criteria
Criteria
Inclusion Criteria:
- All providers included in the BEARI trial
Exclusion Criteria:
- N/A
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- University of Southern California
- National Institute on Aging (NIA)
Investigators
- Principal Investigator: Jason Doctor, PhD, University of Southern California
Study Documents (Full-Text)
None provided.More Information
Publications
- Meeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA. 2016 Feb 9;315(6):562-70. doi: 10.1001/jama.2016.0275.
- Persell SD, Friedberg MW, Meeker D, Linder JA, Fox CR, Goldstein NJ, Shah PD, Knight TK, Doctor JN. Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]--study protocol and baseline practice and provider characteristics. BMC Infect Dis. 2013 Jun 27;13:290. doi: 10.1186/1471-2334-13-290.
- Reiff JS, Zhang JC, Gallus J, Dai H, Pedley NM, Vangala S, Leuchter RK, Goshgarian G, Fox CR, Han M, Croymans DM. When peer comparison information harms physician well-being. Proc Natl Acad Sci U S A. 2022 Jul 19;119(29):e2121730119. doi: 10.1073/pnas.2121730119. Epub 2022 Jul 14.
- HS-11-00249
- 1RC4AG039115