Decreasing Antibiotic Duration for Skin and Soft Tissue Infection Using Behavioral Economics in Primary Care (SSTIBE)

Nationwide Children's Hospital

Status: Completed

Conditions: Cellulitis; Drain Abscess; Impetigo; Skin Infection; Behavioral Economics; Antibiotic Duration; Abscess

Treatments: Behavioral: Default Duration order Panel

Study type: Interventional

Funder types: Other

Identifiers

NCT05226260

STUDY00001964

Details and patient eligibility

About

Study the efficacy of a package of behavioral economics strategies (versus an education-only control condition) in altering clinician behavior regarding antibiotic prescription duration for skin and soft tissue infection (SSTI).

Full description

The investigators propose a prospective, cluster randomized trial of Epic order panels in the 14 Nationwide Children's Hospital (NCH) primary care clinics. Investigators have designed user-friendly Epic order panels from which providers may select guideline concordant antibiotics by simply typing in a diagnosis (cellulitis) or antibiotic name. These order panels are prepopulated with the default, short-course (guideline-concordant) antibiotic duration, saving clinicians several clicks within the electronic medical record (EMR). If a provider changes the prescribed duration from the one defaulted, a free text box will appear for them to write an acknowledgement reason (accountable justification). All 14 clinics will receive baseline education (control condition) about common infections and local and national guidelines for antibiotic choice and duration of treatment. Clinician prescribers will also be instructed about the presence of a basic order panel. The full functionality of the default [short/desired] duration order panel will only be released to intervention clinics. The order panels will be restricted in Epic to clinics randomized to the intervention. The investigators hypothesize that clinics with the intervention will have higher rates of short course antibiotics for SSTI versus control clinics.

Enrollment: 1,634 patients

Sex: All

Ages: 3 months to 99 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• diagnosis codes A46 (cellulitis), L03 (cellulitis and acute lymphangitis), J34 or L02 (abscess, furuncle), or L01 (impetigo) AND
• those who received a prescription for an enteral antibiotic
• patient's treated in Nationwide Children's Hospital primary care clinics

Exclusion criteria

• Patients less than 3 months of age
• Animal bite
• Human bite
• Foreign body
• Diagnosis of hidradenitis suppurativa
• Immunocompromising conditions (primary immune deficiency, chemotherapy, etc)
• burns

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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1,634 participants in 2 patient groups

Intervention

Experimental group

Description:

Intervention clinics receiving fully functional Epic order panel with set default \[short\] duration by diagnosis: for cellulitis and drained abscess, 5 days. For impetigo and undrained abscess, 7 days.

Treatment:

Behavioral: Default Duration order Panel

Control

No Intervention group

Description:

Control clinics receiving basic Epic order panel with antibiotic doses by diagnosis but duration free text (must be entered manually by clinician prescriber).