SHARED DECISION-MAKING AND INAPPROPRIATE ANTIBIOTIC USE

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This proposal requests support for a Mentored Clinical Scientist Award (K08) for Dr. Elizabeth Cox to become an independent researcher in the field of doctor-patient communication, with a focus on the use of shared decision-making to improve quality of care for children. This award will facilitate Dr. Cox's acquisition of advanced research competencies in the science of interpersonal communication in clinical settings. The proposed training program will include completion of a Ph.D. in Population Health, training in analysis of communication during medical interactions, as well as both individual and group mentoring. The University of Wisconsin offers an ideal environment for the proposed work because it provides access to renowned researchers in discourse analysis (Dr. Mary Anne Fitzpatrick), physician satisfaction (Dr. Mark Linzer) and mentoring of women researchers (Drs. Molly Carnes). Dr. Debra Roter (The Johns Hopkins University) will provide mentoring in the analysis of physician-patient communication. Dr. Cox also has strong support from the Department of Population Health Science and the Center for Women's Health Research, Dr. Cox will participate in the UW Clinical Investigator Preparatory Pathway (NIH K30), which assures competency in core areas of statistics, study design, research ethics, management/leadership, and scientific writing. During the period of this training grant, Dr. Cox will develop and validate an instrument to measure shared decision-making in pediatric primary care. This instrument will then be used in a cross-sectional study to examine the relationship of shared decision-making to quality of care outcomes for children's upper respiratory infection. The candidate hypothesizes that shared decision-making in acute primary care visits for upper respiratory infection will decrease inappropriate antibiotic prescribing, while providing satisfaction for both the parent and patient. The proposed research brings the strengths of a multi-disciplinary approach to a common clinical problem in the care of children. Shared decision-making has wide applicability to a variety of acute and chronic healthcare problems. If proven effective, the use of shared decision- making in this clinical setting will result in decreased anti-microbial resistance, decreased adverse events, and decreased cost of care, while preserving visit satisfaction.