TY - JOUR
T1 - The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics
T2 - Experimental Evidence
AU - Eilermann, Kerstin
AU - Halstenberg, Katrin
AU - Kuntz, Ludwig
AU - Martakis, Kyriakos
AU - Roth, Bernhard
AU - Wiesen, Daniel
N1 - Funding Information:
We thank Associate Editor Olga Kostopoulou and the 3 anonymous reviewers for their constructive comments and suggestions. For helpful feedback, we also thank Robert Böhm, Pablo Brañas, Matteo M. Galizzi, Rob Hamm, Glenn Harrison, Heike Hennig-Schmidt, Bernd Irlenbusch, Hendrik Juerges, Brian Monroe, Joe Newhouse, Andrea Rachow, Martin Roland, Don Ross, Gari Walkowitz, and participants in the conferences and research seminars where this work was presented: the 17th Biennial European Conference of the Society for Medical Decision Making in Leiden, the Netherlands, in 2018; the 6th Behavioral Experiments in Health Workshop in Oslo, Norway, in 2018; the annual conference of the German Association for Health Economics (dggö) in Berlin, Germany, in 2016; and research seminars at the University of Cologne, Germany, and the University of Wuppertal, Germany. We are grateful to Jörg Dötsch, MD, and Michael Weiss, MD, for providing support and the facilities to conduct our experiment at the Department of Pediatrics at the University Hospital Cologne and the Children’s Hospital of the City of Cologne, respectively. We thank Angela Kribs, MD, and 5 consultants from the University Hospital Cologne for validating the medical cases. The support of Ronald G. Schmid, MD, and Monika Kraushaar from the Berufsverband der Kinder-und Jugendärzte, BVKJ e.V. is gratefully acknowledged. We also thank Emanuel Castillo for programming the online survey and experiment, Uta Richter from the Department of Personnel Economics at the University of Cologne for facilitating the registration and payment of subjects, and Lena Kuhne for helping us to conduct the experiments. Parts of this research have been done while Daniel Wiesen was employed at the Institute of Health and Society at the Department of Health Management and Health Economics, University of Oslo, and member of the IRECOHEX group, supported by the Research Council of Norway. Financial support for this study was provided by a grant from the Excellence Initiative of the German federal and state governments. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/10
Y1 - 2019/10
N2 - Background. Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians' antibiotic prescribing decisions. Also, the question of how physicians' characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians' antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians (n=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group (n=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors (n=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians' characteristics were elicited in a comprehensive questionnaire. Results. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians' decisions from experts' recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians' clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians' experience. Conclusion. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.
AB - Background. Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians' antibiotic prescribing decisions. Also, the question of how physicians' characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians' antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians (n=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group (n=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors (n=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians' characteristics were elicited in a comprehensive questionnaire. Results. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians' decisions from experts' recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians' clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians' experience. Conclusion. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.
KW - framed field experiment
KW - descriptive feedback
KW - expert benchmark
KW - length of antibiotic therapy
KW - clinical experience
KW - RESPIRATORY-TRACT INFECTIONS
KW - PHYSICIANS RISK ATTITUDES
KW - PRIMARY-CARE
KW - ANTIMICROBIAL STEWARDSHIP
KW - INFORMATION DISTORTION
KW - DECISION-MAKING
KW - PERSONALITY
KW - RESISTANCE
KW - INTERVENTION
KW - DETERMINANTS
U2 - 10.1177/0272989X19866699
DO - 10.1177/0272989X19866699
M3 - Article
C2 - 31423892
SN - 0272-989X
VL - 39
SP - 781
EP - 795
JO - Medical Decision Making
JF - Medical Decision Making
IS - 7
M1 - ARTN 0272989X19866699
ER -