Clinical trial NCT05575115: Non-Inferiority of Peer Comparison Interventions
Official title: Non-Inferiority of Peer Comparison Interventions vs. Control Condition in BEARI Trial
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Respiratory Tract Infections
Keywords: Antibiotics
Inappropriate Prescribing
Behavioral Research
Lead sponsor: University of Southern California
Sponsor class: OTHER
Collaborators: name: National Institute on Aging (NIA)
First posted: 2022-10-12
Enrollment: 201
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study population includes all providers in the BEARI trial. The intent of the BEARI trial was to apply behavioral economic theory to reduce the rate of antibiotic prescriptions for acute respiratory diagnoses for which guidelines do not call for antibiotics.

Brief summary: 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: 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:

1. Differences in physicians' control and agency over patient adherence to screening recommendations vs. their own antibiotic prescribing
2. 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.
3. 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.

Eligibility criteria: Inclusion Criteria:

* All providers included in the BEARI trial

Exclusion Criteria:

* N/A

Primary outcomes:
measure: Job satisfaction
timeFrame: 18 months
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: University of Southern California
name: Jason Doctor, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Persell SD, Friedberg MW, Meeker D, Linder JA, Fox CR, Goldstein NJ, Shah PD, Knight TK, Doctor JN. Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]--study protocol and baseline practice and provider characteristics. BMC Infect Dis. 2013 Jun 27;13:290. doi: 10.1186/1471-2334-13-290.
citation: Meeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA. 2016 Feb 9;315(6):562-70. doi: 10.1001/jama.2016.0275.
citation: Reiff JS, Zhang JC, Gallus J, Dai H, Pedley NM, Vangala S, Leuchter RK, Goshgarian G, Fox CR, Han M, Croymans DM. When peer comparison information harms physician well-being. Proc Natl Acad Sci U S A. 2022 Jul 19;119(29):e2121730119. doi: 10.1073/pnas.2121730119. Epub 2022 Jul 14.