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Randomized controlled trial involving 40 pediatric primary care clinicians with high rates of diagnosing and treating middle ear infections. Ten enrolled clinicians will be randomly assigned to each of 4 arms for a three-month trial: 1) personalized education and feedback about proper ear infection diagnosis; 2) use of a digital otoscope; 3) both education and feedback plus use of a digital otoscope; 4) control (no intervention).
Randomized controlled trial involving 40 pediatric primary care clinicians with rates of otitis media diagnosis and antibiotic prescribing in the top quartile of the entire clinician population of the Pediatric Physicians' Organization at Children's over the previous 12 months who consent to enroll in the trial after direct outreach from the study team. Ten enrolled clinicians will be randomly assigned to each of 4 arms for a three-month intervention period: 1) personalized education and feedback about proper otitis media diagnosis following criteria from the American Academy of Pediatrics; 2) use of the Wispr digital otoscope; 3) both education and feedback plus use of the Wispr digital otoscope; 4) control (no intervention).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Education with personalized performance feedback | Experimental | Education about proper otitis media diagnosis following criteria from the American Academy of Pediatrics with personalized performance feedback on otitis media diagnosis and treatment rates delivered via email |
|
| Use of digital otoscope | Experimental | Use of the Wispr digital otoscope to diagnose otitis media in place of a traditional visual otoscope |
|
| Education with personalized performance feedback plus use of a digital otoscope | Experimental | Education about proper otitis media diagnosis following criteria from the American Academy of Pediatrics with personalized performance feedback on otitis media diagnosis and treatment rates delivered via email plus use of the Wispr digital otoscope to diagnose otitis media in place of a traditional visual otoscope |
|
| Control | No Intervention | Control arm, no intervention |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Education with personalized performance feedback | Other | Education about proper otitis media diagnosis following criteria from the American Academy of Pediatrics with personalized performance feedback on otitis media diagnosis and treatment rates delivered via email |
| Measure | Description | Time Frame |
|---|---|---|
| Change in OMTI | Proportion of encounters in children 6-59 months of age with any respiratory diagnosis who are diagnosed with otitis media and treated with a systemic antibiotic. | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in overall antibiotic courses prescribed | Courses of systemic antibiotics per 1000 children per year among children 6-59 months of age. | 3 months |
| Change in overall prescribed antibiotic days |
| Measure | Description | Time Frame |
|---|---|---|
| Return respiratory illness visits within 7 days (balancing measure) | Proportion of patients with an index encounter with respiratory diagnosis who return to the primary care office for a visit with a respiratory diagnosis within 7 days of the index visit. | 3 months |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Louis Vernacchio, MD, MSc | Pediatric Physicians' Organization at Children's | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Pediatric Physicians' Organization at Children's | Wellesley | Massachusetts | 02115 | United States |
Electronic health record data use for the study are property of the individual practices and may not be shard publicly without their expressed permission.
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| ID | Term |
|---|---|
| D010033 | Otitis Media |
| ID | Term |
|---|---|
| D010031 | Otitis |
| D004427 | Ear Diseases |
| D010038 | Otorhinolaryngologic Diseases |
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| ID | Term |
|---|---|
| D004522 | Educational Status |
| ID | Term |
|---|---|
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
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2x2 factorial design comparing effect of Wispr digital otoscope, education with performance feedback, both, or neither on diagnosis and antibiotic treatment of otitis media in young children.
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|
| Use of digital otoscope | Device | Use of the Wispr digital otoscope to diagnose otitis media in place of a traditional visual otoscope |
|
Total days of systemic antibiotics per 1000 children per year among children 6-59 months of age.
| 3 months |
| Clinician confidence and satisfaction in diagnosing OM and preference for digital versus traditional otoscope | Clinician responses to a pre- and post-intervention surveys regarding confidence in diagnosing otitis media and satisfaction with digital versus traditional otoscope. | 3 months |