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

• 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
• 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

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(申请人提供)：2005年，对抗生素治疗产生抗药性的细菌造成了约94,000例危及生命的感染和18,500多例死亡，比当年死于艾滋病的人数还多(Klevens等人)。2007)。耐药细菌菌株被认为与激进的抗生素处方有关。急性呼吸道感染(ARI)是一种高频率的初级保健问题，抗生素处方往往是没有根据的。使用经济激励(即按绩效付费)来影响医生行为的标准尝试只取得了有限的成功，成本高昂，而且在干预结束后很少持续下去。行为经济学可能会通过吸引提供者的自我形象来持续改善ARI的治疗。首先，我们建议研究加强违约的影响，在这种情况下，抗生素的替代品是假定的行动过程，必须明确证明使用抗生素是合理的。大量研究发现，当替代方案被指定为默认方案时，它们会更受欢迎。其次，我们将研究社会规范，在社会规范中，我们向卫生保健提供者提供对他们自己行为的反馈，一群成功的同龄人很少开不适当抗生素的行为(描述性规范)，以及推荐的指南(禁止性规范)。大量研究表明，人们会努力遵守这些规范。最后，我们将研究在电子健康记录中提供抗生素的显著替代品，促使提供者明确说明他们对抗生素的偏好，并告知他们同事中也喜欢抗生素的(高)比例。我们建议将这些原则应用于全美46个不同临床站点的2x2x2因素组随机试验中的护理点。诊所将随机接受教育和护理提供，包括和不包括增强的默认干预、社会规范和替代处方干预。长期目标是开发一套实用的行为经济学工具，有效地促使提供者在感染治疗中遵守指导方针，并可能在医疗保健提供的其他领域应用。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的安全性；以及2)通过减少不适当和过度使用抗生素疗法和降低耐药感染的流行率，更有效和适当地利用卫生保健资源。 公共卫生相关性：我们的目标是开发一套实用的行为经济学工具，有效地促使提供者在感染治疗中遵守指导方针，并可能在其他医疗保健提供领域应用。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的安全性；以及2)通过减少不适当和过度使用抗生素疗法和降低耐药感染的流行率，更有效和适当地利用卫生保健资源。

项目成果

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

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
• 作者: Meeker D;Thompson C;Strylewicz G;Knight TK;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.

• DOI: 10.1136/bmjopen-2016-012739
• 发表时间: 2016-09-22
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Gong CL;Hay JW;Meeker D;Doctor JN
• 通讯作者: Doctor JN

Patient satisfaction as a quality metric promotes bad medicine--reply.

患者满意度作为质量指标会导致不良药物的产生——回复。

• DOI: 10.1001/jamainternmed.2014.1594
• 发表时间: 2014
• 期刊: JAMA internal medicine
• 影响因子: 39
• 作者: Meeker,Daniella;Friedberg,MarkW;Linder,JeffreyA;BehavioralEconomicsandAcuteRespiratoryInfectionInvestigators
• 通讯作者: BehavioralEconomicsandAcuteRespiratoryInfectionInvestigators

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

nuding指南符合抗生素处方：一项随机临床试验。

• 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