Non-Inferiority of Peer Comparison Interventions

Study Overview
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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.

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

Official Title
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Non-Inferiority of Peer Comparison Interventions vs. Control Condition in BEARI Trial

Conditions
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Respiratory Tract Infections

Intervention / Treatment
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* Behavioral: Peer Comparison


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All providers included in the BEARI trial Exclusion Criteria: N/A

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Peer Comparison<br>Providers from the BEARI trial who received the Peer Comparison intervention. | Behavioral: Peer Comparison<br>* 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.<br>|
| Control<br>Providers from the BEARI trial who did not receive the Peer Comparison intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Job satisfaction | Impact of BEARI Peer Comparison intervention on Job Satisfaction, as measured by the following question completed as part of the BEARI trial exit survey: Please indicate how much you agree or disagree with the following statement. Overall, I am satisfied with my current job. | 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Antibiotics, Inappropriate Prescribing, Behavioral Research