Ambulatory Care, Antibacterial Agents
Conditions
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.
Interventions
BEHAVIORALFeedback on RTD metric
Clinicians in the experimental arm will receive feedback on the RTD metric while clinicians in the No intervention arm will not.
Sponsors
Daniel Livorsi
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 99 Years
Healthy volunteers
Yes
Inclusion criteria
Any clinician who works in Urgent Care or QuickCare clinics within our healthcare system.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of antibiotic-prescribing for RTD visits | 24 hours of visit | Percentage of all qualifying respiratory tract diagnosis (RTD) visits prescribed an antibiotic |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of antibiotic-prescribing for all visits | 24 hours of visit | Percentage of all visits prescribed an antibiotic, regardless of the diagnosis |
| Follow-up visit to Urgent Care or QuickCare | 30 days | Percentage of patients with a qualifying RTD visit who were seen at least once in Urgent Care or QuickCare within the 30 days after their index visit date. |
| Follow-up Emergency Department visit and/or acute-care hospitalization | 30 days | Percentage of patients with a qualifying RTD visit who were seen at least once in the Emergency Department and/or who were hospitalized (any reason) within the 30 days after their index visit date. |
Countries
United States
Outcome results
None listed