Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (Main Study)
NCT ID: NCT01454947
Last Updated: 2024-05-23
Study Results
Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.
View full resultsBasic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
COMPLETED
NA
248 participants
INTERVENTIONAL
2011-08-31
2014-09-30
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
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.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
Use of Behavioral Economics in Repeat SARS-CoV-2 (COVID-19) Antibody Testing in Disadvantaged Communities
NCT04901624
Behavioral Economics to Improve Flu Vaccination Using EHR Nudges Replication
NCT06626321
A Trial of Behavioral Economic Interventions to Reduce Cardiovascular Disease (CVD) Risk
NCT01346189
Behavioral Economics to Improve Flu Vaccination Using EHR Nudges
NCT06057727
Incentives & Motivation for Behavior Change:
NCT04747327
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
Data will be collected from the clinics' Enterprise Data Warehouses which store copies of data recorded in the electronic health record. Data elements from qualifying office visits will be collected from coded portions of the electronic health record.
An encounter is eligible for intervention if the patient's diagnosis is in the selected group of acute respiratory infections. The intervention EHR functions will be triggered when clinicians initiate an antibiotic prescription or enter a diagnosis for an acute respiratory infection that has a defined Order Set. If an antibiotic from a list of frequently misprescribed antibiotics is ordered and a diagnosis has not yet been entered, providers will be prompted to enter a diagnosis. If the diagnosis entered is acute nasopharyngitis; acute laryngopharyngitis/acute upper respiratory infection; acute bronchitis; bronchitis not specified as acute or chronic; or flu; the interventions will be triggered. The diagnosis-appropriate order set will pop-up for providers in the SA arm, while clinicians randomized to the AJ arm will receive an alert and be required to enter a brief statement justifying their antibiotic prescription if antibiotics are not indicated for the diagnosis entered. This note will then be added to the patient's medical record.
Clinicians randomized to the Peer Comparison condition will receive email updates about their antibiotic prescribing practices relative to other clinicians in their practice.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
RANDOMIZED
FACTORIAL
TREATMENT
SINGLE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
SA, AJ, PC
Participants are given all 3 interventions.
Clinical Decision Support (CDS): Accountable Justifications
Accountable Justifications triggered by discordant prescriptions that populate the electronic health record (EHR) note with provider's rationale for guideline exceptions (AJ).
Audit and Feedback: Peer Comparison
Performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison).
CDS Order Sets: Suggested Alternatives
Order Sets that are triggered by EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives).
SA, AJ
Participants receive the Suggested Alternatives and Accountable Justification interventions, but not the Peer Comparison intervention.
Clinical Decision Support (CDS): Accountable Justifications
Accountable Justifications triggered by discordant prescriptions that populate the electronic health record (EHR) note with provider's rationale for guideline exceptions (AJ).
CDS Order Sets: Suggested Alternatives
Order Sets that are triggered by EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives).
SA, PC
Participants receive the Suggested Alternative and Peer Comparison interventions, but not the Accountable Justification intervention.
Audit and Feedback: Peer Comparison
Performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison).
CDS Order Sets: Suggested Alternatives
Order Sets that are triggered by EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives).
AJ, PC
Participants receive the Accountable Justification and Peer Comparison interventions, but not the Suggested Alternative intervention.
Clinical Decision Support (CDS): Accountable Justifications
Accountable Justifications triggered by discordant prescriptions that populate the electronic health record (EHR) note with provider's rationale for guideline exceptions (AJ).
Audit and Feedback: Peer Comparison
Performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison).
Peer Comparison (PC)
Participants receive the Peer Comparison intervention, but do not receive the Suggested Alternatives or Accountable Justification interventions.
Audit and Feedback: Peer Comparison
Performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison).
Suggested Alternatives (SA)
Participants receive the Suggested Alternatives intervention, but not the Accountable Justification or Peer Comparison interventions.
CDS Order Sets: Suggested Alternatives
Order Sets that are triggered by EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives).
Accountable Justification (AJ)
Participants receive the Accountable Justification intervention, but do not receive the Suggested Alternatives or Peer Comparison interventions.
Clinical Decision Support (CDS): Accountable Justifications
Accountable Justifications triggered by discordant prescriptions that populate the electronic health record (EHR) note with provider's rationale for guideline exceptions (AJ).
Education Control
Participants do not receive any of the 3 interventions.
No interventions assigned to this group
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
Clinical Decision Support (CDS): Accountable Justifications
Accountable Justifications triggered by discordant prescriptions that populate the electronic health record (EHR) note with provider's rationale for guideline exceptions (AJ).
Audit and Feedback: Peer Comparison
Performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison).
CDS Order Sets: Suggested Alternatives
Order Sets that are triggered by EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives).
Other Intervention Names
Discover alternative or legacy names that may be used to describe the listed interventions across different sources.
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
Exclusion Criteria
18 Years
ALL
No
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
National Institute on Aging (NIA)
NIH
University of Southern California
OTHER
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Jason Doctor
Associate Professor
Principal Investigators
Learn about the lead researchers overseeing the trial and their institutional affiliations.
Jason N Doctor, PhD
Role: PRINCIPAL_INVESTIGATOR
University of Southern California
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
Altamed Anaheim Lincoln
Anaheim, California, United States
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 El Modena Clinic
Orange, California, United States
Altamed Pico Clinic
Pico Rivera, California, United States
Altamed DVL Pico
Pico Rivera, California, United States
Altamed Santa Ana Main
Santa Ana, California, United States
Altamed Clinic For Women
Santa Ana, California, United States
Altamed Santa Ana Broadway
Santa Ana, California, United States
Altamed Santa Ana Central
Santa Ana, California, United States
Brigham and Women's Primary Care Associates at Foxborough
Boston, Massachusetts, United States
MGH Downtown
Boston, Massachusetts, United States
Mass General Medial Group
Boston, Massachusetts, United States
MGH Beacon Hill
Boston, Massachusetts, United States
MGH Senior Health
Boston, Massachusetts, United States
Women's Health Associates
Boston, Massachusetts, United States
Brigham Circle Medical Associates
Boston, Massachusetts, United States
Brigham Internal Medicine Associates
Boston, Massachusetts, United States
Spanish Clinic
Boston, Massachusetts, United States
MGH Back Bay
Boston, Massachusetts, United States
Brigham and Women's Primary Care Associates of Brookline
Brookline, Massachusetts, United States
MGH Charlestown HealthCare Center
Charlestown, Massachusetts, United States
MGH Chelsea HealthCare Center
Chelsea, Massachusetts, United States
Brigham and Women's Physician Group
Chestnut Hill, Massachusetts, United States
Gretchen and Edward Fish Center for Women's Health
Chestnut Hill, Massachusetts, United States
Everett Family Practice
Everett, Massachusetts, United States
Brigham Primary Physicians at Faulkner
Jamaica Plain, Massachusetts, United States
Brookside Community Health Center
Jamaica Plain, Massachusetts, United States
Faulkner Community Physicians
Jamaica Plain, Massachusetts, United States
Southern Jamaica Plain Health Center
Jamaica Plain, Massachusetts, United States
Brigham and Women's Primary Care Associates of Newton Corner
Newton, Massachusetts, United States
Mass General Revere HealthCare Center
Revere, Massachusetts, United States
Mass General West Medical Group
Waltham, Massachusetts, United States
Countries
Review the countries where the study has at least one active or historical site.
References
Explore related publications, articles, or registry entries linked to this study.
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.
Doctor JN, Goldstein NJ, Fox CR, Linder JA, Persell SD, Stewart EP, Knight TK, Meeker D. Clinician Job Satisfaction After Peer Comparison Feedback: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2317379. doi: 10.1001/jamanetworkopen.2023.17379.
Gong CL, Zangwill KM, Hay JW, Meeker D, Doctor JN. Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis. J Gen Intern Med. 2019 Jun;34(6):846-854. doi: 10.1007/s11606-018-4467-x. Epub 2018 May 8.
Gong CL, Hay JW, Meeker D, Doctor JN. Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment. BMJ Open. 2016 Sep 22;6(9):e012739. doi: 10.1136/bmjopen-2016-012739.
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.
Other Identifiers
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.