Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections

描述（由申请方提供）：2005年，对抗生素治疗耐药的细菌估计造成94，000例危及生命的感染和18，500例死亡，比当年的艾滋病死亡人数更多（Klevens et al. 2007）。耐药菌株与积极的抗生素处方有关。急性呼吸道感染（阿里斯）是一个高频率的初级保健问题，抗生素处方往往是不必要的。使用经济激励来影响医生行为的标准尝试（即，按业绩计薪）取得的成功有限，成本高昂，而且在干预结束后很少能持续下去。行为经济学可以通过吸引提供者的自我形象来持续改善阿里斯的治疗。首先，我们建议研究增强默认的影响，其中抗生素的替代品是假定的行动方针，抗生素的使用必须明确合理。许多研究发现，当替代品被指定为默认选项时，它们会更受欢迎。第二，我们将研究社会规范，其中我们向医疗保健提供者提供关于他们自己行为的反馈，一组成功的同行很少开不适当的抗生素的行为（描述性规范），以及推荐的指南（强制性规范）。许多研究表明，人们努力遵守这些规范。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，并告知他们也喜欢抗生素的同事的比例（高）。我们建议在美国46个不同的临床站点的2 × 2 × 2析因群集随机试验中，在床旁应用这些原则。诊所将被随机分配到教育加护理提供，有或没有增强的默认，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，有效地促使提供者遵守感染治疗的指导方针，并可能在其他领域的医疗保健服务。该项目的成功将导致：1）通过减少抗生素治疗的不适当和过度使用来提高患者安全性; 2）通过减少抗生素治疗的不适当和过度使用以及降低耐药感染的患病率来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应用行为经济学工具，有效地促使提供者遵守感染治疗的指导方针，并可能在其他领域的医疗保健服务的应用。该项目的成功将导致：1）通过减少抗生素治疗的不适当和过度使用来提高患者安全性; 2）通过减少抗生素治疗的不适当和过度使用以及降低耐药感染的患病率来更有效和适当地利用卫生保健资源。

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.