Please select the eligibility criteria that correspond to the clinical trial below.
Title: Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (Pilot Study)
Brief Summary: Bacteria resistant to antibiotic therapy are a major public health problem. The evolution of multi-drug resistant pathogens may be encouraged by provider prescribing behavior. Inappropriate use of antibiotics for nonbacterial infections and overuse of broad spectrum antibiotics can lead to the development of resistant strains. Though providers are adequately trained to know when antibiotics are and are not comparatively effective, this has not been sufficient to affect critical provider practices.

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 EHR workflow containing exclusively guideline concordant choices (SA, for Suggested Alternatives); Accountable Justification (AJ) triggered by discordant prescriptions that populate the note with provider's rationale for guideline exceptions ; and performance feedback that benchmarks providers' own performance to that of their peers (PC, for Peer Comparison).

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.


Options:
A: Inclusion Criteria:

A practicing attending physician or advanced practice nurse ("provider") at Northwestern University's NMFF GIM Clinic in 2011-2013 who sees acute respiratory infection patients.
B: Inclusion Criteria:

* Partners-affiliated pediatric practice providers utilizing Longitudinal Medical Record (LMR), which is an electronic health record system. Also the parents of the patients of the above noted pediatric providers.

Exclusion Criteria:

* Non-Partners providers, or Partners providers who do not use LMR. Parents of patients not seen by Partners-affiliated pediatric providers who use LMR.
C: Inclusion Criteria:

* radiographic evidence of hip OA and / or radiographic of or meets clinical criteria for knee OA
* current joint symptoms
* BMI \>=25
* physically inactive

Exclusion Criteria:

* Diagnosis of rheumatoid arthritis, fibromyalgia, or other systemic rheumatic disease
* Hospitalized for a stroke, myocardial infarction or coronary artery revascularization in the past 3 months
* Active diagnosis of psychosis or serious personality disorder
* On waiting list for / planning arthroplasty
* Severely impaired hearing or speech (patients must be able to respond to phone calls)
* Unable to speak English
* No access to a telephone
* Participating in another OA intervention or other lifestyle change study
* Dementia or other memory loss condition
* Current, uncontrolled substance abuse disorder
* Motor neuron diseases, Parkinson's Disease, multiple sclerosis
* Quadriplegic or paraplegic
* Serious / terminal illness as indicated by referral to hospice or palliative care
* Other self-reported health problem that would prohibit participation in the study
* Nursing home resident
* Other health conditions or personal issues judged by a study team member or primary care physician to make the patient inappropriate for the study
* Female participants: pregnant or planning to become pregnant
* Metastatic Cancer
* History of gout in knee or hip
* Total joint replacement (knee or hip) surgery, other knee or hip surgery, meniscus tear (verified by MRI), or ACL tear in the past 6 months
* Have not seen their VA-assigned primary health care provider for more than a year
D: Inclusion Criteria:

* child is age 6.0 through 12.9 years at baseline
* child's BMI exceeds the 95th percentile for age and sex (CDC criteria
* parent can respond to interviews and questionnaires in English
* child has obtained well-child care from HVMA for at least the previous 15 months.

Exclusion Criteria:

* children who do not have at least one parent who is able to follow study procedures for 1 year
* families who plan to leave HVMA within the study time frame
* families for whom the primary care clinician thinks the intervention is inappropriate, e.g., emotional or mental difficulties
* children with chronic conditions that substantially interfere with growth

Answer: A