Improving Antibiotic Prescribing for Pediatric Acute Respiratory Tract Infections: Cluster Randomized Trial to Evaluate Individual Clinician Compared With Clinic-level Feedback
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 39
- Primary Endpoint
- Proportion of encounters with guideline-appropriate use of antibiotics for upper respiratory tract infection (URI or common cold) in participants 3 months - 18 years of age
Study Overview
Brief Summary
Findings from an ongoing improvement project to improve antibiotic prescribing for children and adolescents for three acute respiratory tract infections (ARTIs: upper respiratory tract infection, acute bacterial sinusitis, and acute otitis media) among pediatric and family medicine clinics revealed performance gaps between the two primary care specialties. An improvement project was then set up to address the lower performance by family medicine clinics.
Literature review revealed that, in general, quality improvement feedback was more effective if provided to individual clinicians rather than to a group of clinicians, but very limited data existed for antibiotic prescribing practices actually comparing individual clinician feedback to group (clinic-level) feedback.
The hypothesis is that individual clinician data feedback is superior to group (clinic-level) feedback in improving antibiotic prescribing for ARTIs in children and adolescents by family medicine clinicians.
The aim is to determine if there are significant differences for antibiotic prescribing for ARTIs and for broad spectrum antibiotic prescribing percentage between an intervention group and a comparator group of family medicine clinics after the intervention starting November 2015 and ending December 2018.
A cluster randomized trial was designed for 39 family medicine clinics. The intervention group received clinician-level and clinic-level data feedback monthly, and the comparator group received clinic-level only feedback monthly.
Detailed Description
Introduction/Background
Findings from an ongoing improvement project to improve antibiotic prescribing for children and adolescents for three acute respiratory tract infections (ARTIs: upper respiratory tract infection, acute bacterial sinusitis, and acute otitis media) among pediatric and family medicine clinics revealed performance gaps between the two primary care specialties. An improvement project was then set up to address the lower performance by family medicine clinics.
Literature review revealed that, in general, quality improvement feedback was more effective if provided to individual clinicians rather than to a group of clinicians, but very limited data existed for antibiotic prescribing practices actually comparing individual clinician feedback to group (clinic-level) feedback.
The hypothesis is that individual clinician data feedback is superior to group (clinic-level) feedback in improving antibiotic prescribing for ARTIs in children and adolescents by family medicine clinicians.
The aim is to determine if there are significant differences for antibiotic prescribing for ARTIs and for broad spectrum antibiotic prescribing percentage between an intervention group and a comparator group of family medicine clinics after the intervention starting November 2015 and ending December 2018.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Other
- Masking
- None
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Family Medicine clinic in Novant Health Medical Group with performance on the upper respiratory infection measure < 85 per cent for the 6-month period, January- June 2015
- •Email agreement to participate for the clinic by the lead clinician for the clinic.
Exclusion Criteria
- •Family Medicine clinic in Novant Health Medical Group with performance on the upper respiratory infection measure ≥ 83 per cent for the 6-month period, January - June 2015,
- •< 20 illness encounters for the upper respiratory infection measure recorded by the clinic for the 6-month period, January - June 2015,
- •Email declination for the clinic by the lead clinician for the clinic
Arms & Interventions
Clinician-level and clinic-level monthly feedback
Group of 22 clinics to receive clinician-level and clinic-level monthly feedback on appropriate antibiotic use for three acute respiratory tract infections
Intervention: Peer comparison feedback monthly (Behavioral)
Clinic-level only monthly feedback
Group of 17 clinics to receive clinic-level only monthly feedback on appropriate antibiotic use for three acute respiratory tract infections
Intervention: Peer comparison feedback monthly (Behavioral)
Outcomes
Primary Outcomes
Proportion of encounters with guideline-appropriate use of antibiotics for upper respiratory tract infection (URI or common cold) in participants 3 months - 18 years of age
Time Frame: 60 months, January 1, 2014 - October 31, 2015 (baseline period), November 1, 2015 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period)
Measurement tool is electronic health record review of * Illness encounters in the time frame for diagnosis codes for URI or common cold * Antibiotics dispensed the day of the URI or common cold diagnosis encounter or 3 days subsequently * Antibiotics dispensed in the previous 30 days
Proportion of encounters with guideline-appropriate use of antibiotics for acute otitis media in participants 6 months - 12 years years of age
Time Frame: 60 months, January 1, 2014 - October 31, 2015 (baseline period), November 1, 2015 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period)
Measurement tool is electronic health record review of * Illness encounters in the time frame for diagnosis codes for acute otitis media * Antibiotics dispensed the day of the acute otitis media diagnosis encounter or 3 days subsequently * Antibiotics dispensed in the previous 60 days
Proportion of encounters with guideline-appropriate use of antibiotics for acute bacterial sinusitis in participants 1 - 18 years of age
Time Frame: 60 months,January 1, 2014 - October 31, 2015 (baseline period), November 1 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period)
Measurement tool is electronic health record review of * Illness encounters in the time frame for diagnosis codes for acute bacterial sinusitis * Antibiotics dispensed the day of the acute bacterial sinusitis diagnosis encounter or 3 days subsequently * Antibiotics dispensed in the previous 60 days
Secondary Outcomes
- Mean baseline-to-intervention period change in broad-spectrum antibiotic prescribing percentage(60 months, January 1, 2014 - October 31, 2015 (baseline period), November 1, 2015 - December 31, 2017 (intervention period), and January 1, 2017 - December 31, 2018 (post-intervention period))
Investigators
Herb Clegg
Senior Vice President, Clinical Excellence, Novant Health
Forsyth Medical Center