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RELAX: Reducing Length of Antibiotics For Children With Ear Infections

Award Number: R01HS029153
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/30/2022
PERIOD OF PERFORMANCE END DATE: 09/29/2027

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RELAX: Reducing Length of Antibiotics For Children With Ear Infections - PROJECT SUMMARY/ABSTRACT: Acute otitis media (AOM) is the most commonly cited indication for antibiotics in children, accounting for 24% of all pediatric antibiotic prescriptions and affecting 60% of children by 3 years of age. For most children ≥ 2 years of age with AOM, 5-7 days, rather than 10 days, of antibiotics have been shown to be sufficient and result in fewer adverse drug events with similar failure and recurrence rates. Thus, national guidelines recommend short durations of antibiotics for non-severe AOM in this age group. Despite these recommendations, >94% of children ≥2 years of age are prescribed longer than recommended antibiotic durations and over 41% of antibiotic exposure days for AOM in this age group are likely unnecessary. In a recent pilot study that compared a low-cost High-intensity intervention with clinician education, individualized clinician audit and feedback with peer comparison and electronic health record (EHR) changes of prescription fields to a Low-intensity intervention with only EHR changes prescribing of recommended short antibiotic durations increased significantly (76% and 50%, absolute percentage). A definite study is needed to make appropriate recommendations on which intervention to implement, while minimizing resource utilization. The overarching goal of this study is to evaluate the effectiveness and implementation outcomes of two low-cost pragmatic interventions of different intensities to increase prescribing of recommended short antibiotic durations for AOM for children 2 years of age and older. A multi-center cluster randomized controlled trial using a hybrid type 2 implementation effectiveness design will be used to evaluate interventions. The High-intensity intervention will include clinician education, individualized clinician audit and feedback with peer comparison, and EHR changes of prescription fields, whereas the Low-intensity intervention will include clinician education and EHR changes. In total, 46 community-based clinics and/or urgent care centers across two distinct geographic regions in the United States will be randomized to one of the two interventions. The Practical Robust Implementation and Sustainability Model will be used to guide implementation and the Reach Effectiveness Adoption Implementation Maintenance framework will be used to evaluate outcomes. A mixed- methods approach will be used in the pre-implementation and evaluation phases and will utilize quantitative analyses, semi-structured interviews, focus groups, surveys, and cost analyses. National stakeholders at the American Academy of Pediatrics and the Centers for Disease Control and Prevention will assist with dissemination of findings and scaling of interventions.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $460,637 )
2024	2024	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 2200	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Research on Healthcare Costs, Quality and Outcomes	001	3	9/20/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$460,637
2024	2023	DENVER HEALTH AND HOSPITAL AUTHORITY	777 BANNOCK ST	DENVER	CO	80204	DENVER	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	9/20/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $460,637

Issue Date FY: 2023 ( Subtotal = $456,454 )
2023	2023	DENVER HEALTH AND HOSPITALS AUTHORITY	777 BANNOCK ST	DENVER	CO	80204	DENVER	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	9/14/2023	NON-COMPETING CONTINUATION	$456,454
2023	2022	DENVER HEALTH AND HOSPITALS AUTHORITY	777 BANNOCK ST	DENVER	CO	80204	DENVER	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/14/2023	NEW	$0
														Subtotal = $456,454

Issue Date FY: 2022 ( Subtotal = $498,699 )
2022	2022	DENVER HEALTH AND HOSPITALS AUTHORITY	777 BANNOCK ST	DENVER	CO	80204	DENVER	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/22/2022	NEW	$498,699
														Subtotal = $498,699

Grand Total All Awards = $1,415,790

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RELAX: Reducing Length of Antibiotics For Children With Ear Infections

Award Number: R01HS029153

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/30/2022

PERIOD OF PERFORMANCE END DATE: 09/29/2027

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