Randomized-controlled Trial to Assess Whether Feedback on a New Stewardship Metric Can Improve Antibiotic-prescribing for Acute Respiratory Tract Infections in Urgent Care Clinics
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Antibacterial Agents
- Sponsor
- Daniel Livorsi
- Enrollment
- 90
- Locations
- 1
- Primary Endpoint
- Frequency of antibiotic-prescribing for RTD visits
- Status
- Active, not recruiting
- Last Updated
- 4 months ago
Overview
Brief Summary
Many clinicians prescribe antibiotics for patients with acute respiratory infections even when antibiotics will not benefit the patient because the infection is due to a virus. To discourage this type of unnecessary antibiotic use, the investigators will assess whether it is helpful to give clinicians feedback on how often they prescribe antibiotics for respiratory infections in comparison to their peers. The investigators will perform this study across Urgent Care and QuickCare clinics within a single healthcare system.
Detailed Description
The investigators have used an established HEDIS (Healthcare Effectiveness Data and Information Set) metric to evaluate Urgent Care and QuickCare clinicians on their antibiotic use for respiratory tract diagnoses (RTDs). This RTD metric excludes visits that are more complicated, based on well-defined criteria. Based on our baseline assessment (2018-2022), the investigators estimate that most clinicians in this setting are frequently prescribing unnecessary antibiotics. The investigators will perform a randomized controlled trial to assess whether providing individualized feedback to clinicians on the RTD metric can safely reduce antibiotic use for qualifying respiratory tract visits across Urgent and QuickCare settings within a single integrated healthcare system. Clinicians who do not opt-out of the trial will be randomized to either receive feedback or not receive feedback on this RTD metric. The trial will last for 18 months. The primary outcome of effectiveness will be the frequency of antibiotic-prescribing for RTD visits. Secondary outcomes include total antibiotic use (regardless of diagnosis), changes in the use of diagnostic codes, 30-day rates of follow-up visits and hospital admissions. The RE-AIM framework will be used to guide additional study evaluation.
Investigators
Daniel Livorsi
Associate Professor
University of Iowa
Eligibility Criteria
Inclusion Criteria
- Not provided
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Frequency of antibiotic-prescribing for RTD visits
Time Frame: 24 hours of visit
Percentage of all qualifying respiratory tract diagnosis (RTD) visits prescribed an antibiotic
Secondary Outcomes
- Frequency of antibiotic-prescribing for all visits(24 hours of visit)
- Follow-up visit to Urgent Care or QuickCare(30 days)
- Follow-up Emergency Department visit and/or acute-care hospitalization(30 days)