Use of a Behavioral Economic Intervention to Reduce Antibiotic Prescription for Upper Respiratory Infections

National prescription rates for low-value antibiotics for uncomplicated upper respiratory
infections (URIs) remain unacceptably high, including at LAC+USC Medical Center—one of the
largest safety net medical centers in the U.S. Using a quasi-experiment (pre-post) design,
antibiotic prescriptions for URI at LAC+USC Urgent Care Center (intervention site) vs. Olive
View-UCLA Urgent Care Center (control site) will be compared. A three-part intervention at
LAC+USC consists of (1) the urgent care medical director emailing Choosing Wisely® guidelines
and presented journal club to all 16 urgent care clinicians, and then (2) leveraging EHR
performance data to provide individual clinicians with case-specific audit-feedback (both via
emails and in-person while precepting nurse practitioners) on low-value antibiotic
prescribing, and (3) using a behavioral "nudge", urgent care clinicians will sign a large
poster committing to avoid prescribing low-value antibiotics for uncomplicated URIs, which
will be displayed in the clinic. In contrast, the control site (Urgent Care Center at Olive
View-Medical Center) will receive Centers for Disease Control prescription pads for
non-antibiotic treatments (e.g., decongestants) that offer patients alternatives to
antibiotics, in a broader health system effort to reduce antibiotic prescribing. Patient with
URIs (e.g., acute bronchitis, bronchitis NOS, excluding guideline-based red flags such as
COPD, HIV) will be identified using electronic health record clinical billable data and
low-value antibiotic prescriptions rates per visit will be monitored at both sites.
Differences in prescriptions rates will be determined using an interrupted time-series
analysis comparing utilization between sites using a repeated measures logistic regression
model.

Inclusion Criteria:

- all patient receiving treatment for Upper Respiratory Infections (defined by ICD codes
EHR billable codes) at both LAC+USC Medical Center Urgent Care or Olive View-UCLA
Medical Center

Exclusion Criteria:

- Patients not receiving treatment for Upper Respiratory Infections at both LAC+USC
Medical Center Urgent Care or Olive View-UCLA Medical Center