Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections

利用行为经济学改善急性呼吸道感染的治疗

基本信息

批准号：
8060256
负责人：
JASON N. DOCTOR
金额：
$ 1146.4万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-30 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8060256
关键词：
Accounting Acquired Immunodeficiency Syndrome Acute respiratory infection Antibiotic Resistance Antibiotic Therapy Antibiotics Area Bacteria Behavior Behavioral Caring Cessation of life Clinic Diagnosis Disease Economics Education Electronic Health Record Electronics Engineering Feedback Frequencies Goals Guidelines Health Personnel Incentives Individual Infection Intervention Lead Life Link Measures Names Performance Pharmaceutical Preparations Phase Physicians Prevalence Primary Health Care Provider Randomized Resistance Resources Self Perception Site Specific qualifier value System Testing Time United States Virus Diseases bacterial resistance clinical research site effective therapy health care delivery health care service utilization improved patient safety peer point of care preference randomized trial social success tool uptake

项目摘要

DESCRIPTION (provided by applicant): Bacteria resistant to antibiotic therapy accounted for an estimated 94,000 life-threatening infections and over 18,500 deaths in 2005, more deaths than from AIDS that year (Klevens et al. 2007). Resistant bacterial strains have been linked to aggressive antibiotic prescribing. Acute respiratory infections (ARIs) are a high frequency primary care problem for which antibiotics prescriptions are often unwarranted. Standard attempts to influence physician behavior using economic incentives (i.e., pay-for-performance) have had limited success, are costly, and rarely persist after the intervention ends. Behavioral economics may improve treatment of ARIs in a sustained way by appealing to providers' self-image. First, we propose to study the impact of enhanced defaults, in which alternatives to antibiotics are the presumed course of action and use of antibiotics must be explicitly justified. Numerous studies have found that alternatives are much more popular when they are designated the default. Second, we will study social norms, in which we present health care providers with feedback on their own behavior, the behavior of a group of successful peers who rarely prescribe inappropriate antibiotics (descriptive norm), and the recommended guidelines (injunctive norm). Numerous studies have shown that people strive to conform to such norms. Finally, we will study providing salient alternatives to antibiotics in electronic health records, prompting providers to explicit state their preferences for them, and informing them of the (high) proportion of colleagues who also prefer them. We propose to apply these principles at the point-of-care in a 2 x 2 x 2 factorial cluster randomized trial with 46 diverse clinical sites across the United States. Clinics will be randomized to education plus care provision with and without an enhanced default, social norm, and alternative prescribing interventions. The long-term objective is to develop a set of applied behavioral economic tools that are effective in prompting providers to adhere to guidelines in infection treatment, and which may have application in other areas of health care delivery. The success of this project will result in: 1) increased patient safety through a reduction in inappropriate and overuse of antibiotic therapies; and 2) more efficient and appropriate utilization of health care resources by reducing inappropriate and overuse of antibiotic therapies and decreasing the prevalence of medication resistant infections. PUBLIC HEALTH RELEVANCE: We aim to develop a set of applied behavioral economic tools that are effective in prompting providers to adhere to guidelines in infection treatment and which may have application in other areas of health care delivery. The success of this project will result in: 1) increased patient safety through a reduction in inappropriate and overuse of antibiotic therapies; and 2) more efficient and appropriate utilization of health care resources by reducing inappropriate and overuse of antibiotic therapies and decreasing the prevalence of medication resistant infections.

描述（由申请人提供）：对抗生素疗法的细菌估计估计有94,000人威胁生命的感染，2005年死亡的死亡人数超过18,500人，而死亡人数比当年的艾滋病多（Klevens等人，2007年）。抗性细菌菌株与侵袭性抗生素处方有关。急性呼吸道感染（ARIS）是一个高频初级保健问题，抗生素处方通常是不必要的。使用经济激励措施（即，绩效付费）影响医师行为的标准尝试的成功有限，昂贵，并且在干预结束后很少持续下去。行为经济学可以通过吸引提供者的自我形象来持续改善ARIS的待遇。首先，我们建议研究增强默认值的影响，其中抗生素的替代方法是假定的行动方案和抗生素的使用方案，必须明确证明是合理的。许多研究发现，当替代方案被指定为默认值时，它们更加受欢迎。其次，我们将研究社会规范，其中我们向医疗保健提供者提供了有关其自身行为的反馈，一群成功的同龄人的行为，这些同行很少开处方不适当的抗生素（描述性规范）以及推荐的准则（禁令规范）。许多研究表明，人们努力遵守此类规范。最后，我们将研究电子健康记录中抗生素的显着替代品，促使提供者明确说明他们对他们的偏好，并向他们通报（高）同事的比例，他们也喜欢它们。我们建议在2 x 2 x 2阶乘群集随机试验中应用这些原则，在美国各地有46个不同的临床部位。诊所将被随机分配给教育，并在有和没有增强默认，社会规范和替代处方干预措施的情况下进行护理。长期目标是开发一套应用的行为经济工具，这些工具有效地促使提供者遵守感染治疗中的准则，并可能在其他医疗保健提供领域中应用。该项目的成功将导致：1）通过减少不适当和过度使用抗生素疗法来提高患者安全性； 2）通过减少不适当和过度使用抗生素疗法并降低抗药性感染的患病率，从而更有效，更适当地利用医疗保健资源。公共卫生相关性：我们旨在开发一系列应用的行为经济工具，这些工具有效地促使提供者遵守感染治疗中的准则，并可能在其他医疗保健提供领域中应用。该项目的成功将导致：1）通过减少不适当和过度使用抗生素疗法来提高患者安全性； 2）通过减少不适当和过度使用抗生素疗法并降低抗药性感染的患病率，从而更有效，更适当地利用医疗保健资源。

项目成果

期刊论文数量（13）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Use of Insurance Against a Small Loss as an Incentive Strategy.

DOI：
10.1287/deca.2015.0314
发表时间：
2015-09
期刊：
Decision analysis : a journal of the Institute for Operations Research and the Management Sciences
影响因子：
0
作者：
Meeker D;Thompson C;Strylewicz G;Knight TK;Doctor JN
通讯作者：
Doctor JN

Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial.

DOI：
10.1186/s12879-016-1715-8
发表时间：
2016-08-05
期刊：
BMC infectious diseases
影响因子：
3.7
作者：
Persell SD;Doctor JN;Friedberg MW;Meeker D;Friesema E;Cooper A;Haryani A;Gregory DL;Fox CR;Goldstein NJ;Linder JA
通讯作者：
Linder JA

Moving the mean with feedback: insights from behavioural science.

DOI：
10.1038/npjpcrm.2016.18
发表时间：
2016-04-28
期刊：
NPJ primary care respiratory medicine
影响因子：
3.1
作者：
Linder JA
通讯作者：
Linder JA

Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial.

DOI：
10.1001/jamainternmed.2013.14191
发表时间：
2014-03
期刊：
JAMA internal medicine
影响因子：
39
作者：
Meeker D;Knight TK;Friedberg MW;Linder JA;Goldstein NJ;Fox CR;Rothfeld A;Diaz G;Doctor JN
通讯作者：
Doctor JN

Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment.