Interventions to De-implement Unnecessary Antibiotic Prescribing for Children With Ear Infections (DISAPEAR)
Acute Otitis Media, Ear Infection, Pediatric Infectious Disease
About this trial
This is an interventional health services research trial for Acute Otitis Media focused on measuring Shared Decision-Making, Health-System Level Intervention
Eligibility Criteria
Inclusion Criteria: A. Implementation of Interventions 1. Clinic at a participating organization 2. Provides care to children with AOM 3. Administrative or local approval for participation B. Secondary Electronic Health Record Data Aged 6 months-17-years-old (inclusive) Diagnosis of AOM by ICD10 code C. Video recordings or direct observation of the use of a shared decision aid Parent participation: Child aged 6 months-17 years (inclusive) Diagnosed with AOM by clinician Parent or legal guardian is present and is >=18 years or older Clinician Participation: Licensed clinician and not a medical trainee Age 18 >= years or older D. Pre-implementation interviews of clinicians and administrators Licensed clinician (physician or advanced practice clinician) that cares for children with AOM at a participating organization or an administrator/manager at a participating organization. Aged >=18 years-no maximum E. Pre-implementation focus groups of parents Parent or legal guardian of a child aged 6 months-17 years (inclusive) that has had AOM diagnosed at a participating organization. 18 years of age or older and able/willing to consent F. Parents enrolled for surveys 1. Parent or legal guardian of a child aged 6 months-17 years (inclusive) that has had AOM diagnosed at a participating organization. 2. Willing to participate and able to complete electronic surveys at enrollment and 10 days after enrollment. 3. Working phone 4. Age >=18 years of age G. Post-intervention focus groups of parents Parent or legal guardian of a child aged 6 months-17 years (inclusive) that has had AOM diagnosed at a participating organization. 18 years of age or older and able/willing to consent H. Post-intervention surveys of clinicians and administrators Licensed clinician (physician or advanced practice clinician) that cares for children with AOM at a participating organization or an administrator/manager at a participating organization. Aged >=18 years-no maximum Exclusion Criteria: A. Implementation of Interventions 1. Clinics that exclusively provide telehealth B. Secondary Electronic Health Record Data 1. None C. Video recordings or direct observation of the use of a shared decision aid Parent participation: 1. None Clinician Participation: 1. None D. Pre-implementation interviews of clinicians and administrators 1. Medical trainee (student, resident, fellow, etc.) E. Pre-implementation focus groups of parents 1. None F. Parents enrolled for surveys 1. Complicated or recurrent AOM as determined by the study team G. Post-intervention focus groups of parents 1. None H. Post-intervention surveys of clinicians and administrators 1. Medical trainee (student, resident, fellow, etc.)
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Health System Level (HSL) Intervention
Hybrid Intervention
The HSL Intervention is based on the CDC Core Elements of Stewardship and the HSL intervention is recommended by national guidelines. Sites randomized to this arm will require: A change in their Electronic Health Record to their prescription fields to align with national guidelines Individualized feedback report to their clinicians and clinic overall And virtual learning sessions and continuing medical education credits for clinicians.
The Hybrid Intervention will be comprised of Shared Decision-Making (SDM) and the HSL Intervention. A previously validated SDM aid for ear infection care will be implemented. The aid was developed using the International Patient Decision Aid Standards and is freely available. Sites randomized to this arm will require all of the HSL components as well as: Use of the Shared-Decision Aide Clinician Education on SDM