Non-Inferiority of Peer Comparison Interventions

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

201 participants

Study Classification

OBSERVATIONAL

Study Start Date

2011-11-01

Study Completion Date

2014-09-01

Brief Summary

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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.

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Detailed Description

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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:

1. Differences in physicians' control and agency over patient adherence to screening recommendations vs. their own antibiotic prescribing
2. 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.
3. 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.

Conditions

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Respiratory Tract Infections

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Peer Comparison

Providers from the BEARI trial who received the Peer Comparison intervention.

Peer Comparison

Intervention Type BEHAVIORAL

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.

Control

Providers from the BEARI trial who did not receive the Peer Comparison intervention.

No interventions assigned to this group

Interventions

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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.

Intervention Type BEHAVIORAL