Dialogue Around Respiratory Illness Treatment

 描述（由申请方提供）：儿科急性呼吸道感染（ARTIs）中抗生素的不当使用以及细菌性ARTIs中二线广谱抗生素的使用导致许多细菌菌株的耐药性快速发展。ART儿科访视期间的提供者-家长沟通强烈影响抗生素处方率。这项研究的总体目标是开发和测试一个远程学习质量改善（QI）计划，称为围绕呼吸系统疾病治疗对话- DART。DART计划旨在改善儿科阿尔蒂访视期间的提供者沟通实践和治疗决策，最终目标是降低儿童这些疾病的抗生素处方率。 本研究的具体目的是：1）t检验DART计划在以下方面的有效性：a）所有儿科ART的总体抗生素处方率和B）细菌性ART的一线抗生素处方率（急性中耳炎，组 链球菌性咽炎和鼻窦炎），2）测试DART计划在改变阿尔蒂访问期间提供者的沟通实践中的有效性，3）确定研究提供者所见儿童的父母的访问特定满意度水平，并评估满意度如何作为暴露于DART计划的函数而变化，评估实施灾难援助反应队计划的成本及其对卫生保健支出的影响。 为了实现这些目标，我们提出了一个准实验研究，利用阶梯式楔形设计。与两个基于实践的研究网络合作：电子儿科研究办公室设置（ePROS）网络和北岸儿科网络，我们将招募25个实践参与。在8个月的时间里，干预措施将依次部署到 五个研究小组（五种做法/小组）。每个实践将作为控制组的一部分，直到他们接受干预。DART计划的有效性将通过使用调查和电子健康记录数据检查供应商ART的抗生素处方率（总体和一线）、沟通实践以及干预前和干预后暴露的家长满意度来评估。如果DART计划能够有效地将阿尔蒂抗生素处方减少到与细菌流行率一致的水平，并增加细菌ARTI的一线抗生素使用，我们将有一个创新的，高度传播的QI干预计划，以进一步解决这一关键的公共卫生问题。

 DESCRIPTION (provided by applicant): Unwarranted use of antibiotics for pediatric acute respiratory tract infections (ARTIs) and use of second-line, broad spectrum antibiotics for bacterial ARTIs has contributed to the rapid development of resistance in many strains of bacteria. Provider-parent communication during pediatric visits for ARTIs strongly influences antibiotic prescribing rates. The overall goal of this study is to develop and test a distance learning quality improvement (QI) program called Dialogue Around respiratory Illness Treatment - DART. The DART program will aim to improve provider communication practices and treatment decisions during pediatric ARTI visits, with the ultimate goal being to decrease rates of antibiotic prescribing for these illnesses in children. The specific aims of the study are:1) t test the DART program's effectiveness on a) overall antibiotic prescribing rates for all pediatric ARTIs and b) first-line antibiotic prescribing rates for bacterial ARTIs (acute otitis media, Group A Streptococcal pharyngitis, and sinusitis), 2) to test the DART program's effectiveness in changing providers' communication practices during ARTI visits, 3) to determine visit-specific satisfaction levels for parents of children seen by study providers and assess how satisfaction changes as a function of exposure to the DART program, and 4) to assess the cost of implementing the DART program and its impact on health care expenditures. To accomplish these aims, we propose a quasi-experimental study utilizing a stepped wedge design. In collaboration with two practice-based research networks: the electronic Pediatric Research in Office Settings (ePROS) network and the NorthShore Pediatric network, we will recruit 25 practices to participate. Over an 8 month period, the intervention will be sequentially deployed to five study groups (five practices/group). Each practice will function as part of the control group until they receive the intervention. The DART program's effectiveness will be assessed by examining provider antibiotic prescribing rates for ARTIs (both overall and first-line), communication practices, and parent satisfaction both pre- and post-intervention exposure using survey and electronic health record data. If the DART program is effective for both reducing ARTI antibiotic prescribing to levels consistent with bacterial prevalence rates and increasing use of first-line antibiotics for bacterial ARTIs, we will have an innovative, highly disseminable QI intervention program to further address this critical public health problem.