Respiratory Tract InfectionsNCT05575115
Non-Inferiority of Peer Comparison Interventions
An observational study of Respiratory Tract Infections, run by University of Southern California.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Respiratory Tract Infections
- What is being tested?
- Peer Comparison
- Type of treatment
- Lifestyle or therapy programme
- How many people
- 201 participants
- Where
- No sites listed yet
- Study dates
- 1 Nov 2011to 1 Sep 2014
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
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.
Who may be able to join
- All providers included in the BEARI trial
Who cannot join
- N/A
About this study
Official title: Non-Inferiority of Peer Comparison Interventions vs. Control Condition in BEARI Trial
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.
Read the 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:
- 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.
- Conditions
- Respiratory Tract Infections
- Being tested
- Peer Comparison
- Keywords
- Antibiotics, Inappropriate Prescribing, Behavioral Research
- Medical subject headings
- Respiratory Tract Infections
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Peer ComparisonBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| Peer Comparison | Providers from the BEARI trial who received the Peer Comparison intervention. Receives: Behavioral: Peer Comparison | |
| Control | Providers from the BEARI trial who did not receive the Peer Comparison intervention. |
What is being measured
The primary outcome is the main question the study is designed to answer.
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."
Measured: 18 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Oct 2022
- Study start1 Nov 2011
- Primary completion1 Apr 2014
- Study completion1 Sep 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Respiratory Tract InfectionsStudies of the same condition, open and under way.
- More trials run by University of Southern CaliforniaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 201 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Southern California
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute on Aging (NIA)
- Responsible party
- Principal investigator, Jason Doctor, University of Southern California
- Investigators
- Jason Doctor, PhD, Principal investigator, University of Southern California
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05575115
- Sponsor's protocol ID
- HS-11-00249
- Other IDs
- 1RC4AG039115
- Status last verified
- Oct 2022
- First submitted
- 5 Oct 2022
- Last updated
- 12 Oct 2022
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
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.
PubMed 23806017Meeker 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.
PubMed 26864410Reiff 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.
PubMed 35858307Doctor JN, Goldstein NJ, Fox CR, Linder JA, Persell SD, Stewart EP, Knight TK, Meeker D. Clinician Job Satisfaction After Peer Comparison Feedback: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2317379. doi: 10.1001/jamanetworkopen.2023.17379.
PubMed 37289454
Study at a glance
From the registry record, last updated by the sponsor on 12 Oct 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Non-Inferiority of Peer Comparison Interventions vs. Control Condition in BEARI Trial
- ClinicalTrials.gov ID
- NCT05575115
- Acronym / sponsor ID
- HS-11-00249
- Conditions
- Respiratory Tract Infections
- Keywords
- Antibiotics, Inappropriate Prescribing, Behavioral Research
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 201 participants (actual)
- Lead sponsor
- University of Southern CaliforniaUniversity, hospital or other
- Collaborators
- National Institute on Aging (NIA)
- Study start
- 1 Nov 2011 (actual)
- Primary completion
- 1 Apr 2014 (actual)
- Study completion
- 1 Sep 2014 (actual)
- First posted
- 12 Oct 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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:
- 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.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Peer Comparison | – | Behavioral: Peer ComparisonProviders from the BEARI trial who received the Peer Comparison intervention. |
| Control | – | –Providers from the BEARI trial who did not receive the Peer Comparison intervention. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- 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.
Key inclusion criteria (1 listed)
- All providers included in the BEARI trial
Key exclusion criteria (1 listed)
- N/A
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Peer ComparisonPeer 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. | Behavioural | Peer Comparison |
Primary outcome
Job satisfaction
Time frame: 18 months
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."
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Oct 2022.
- Background: PubMed 23806017Persell 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.
- Background: PubMed 26864410Meeker 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.
- Background: PubMed 35858307Reiff 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.
- Derived from this study: PubMed 37289454Doctor JN, Goldstein NJ, Fox CR, Linder JA, Persell SD, Stewart EP, Knight TK, Meeker D. Clinician Job Satisfaction After Peer Comparison Feedback: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2317379. doi: 10.1001/jamanetworkopen.2023.17379.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Jason Doctor, PhD principal investigator
University of Southern California
Questions about this trial
What is this clinical trial studying?
An observational study of Respiratory Tract Infections, run by University of Southern California.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Job satisfaction (time frame: 18 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05575115, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Oct 2022.