Interventions to De-implement Unnecessary Antibiotic Prescribing for Children With Ear Infections

Inclusion Criteria:

A. Implementation of Interventions 1. Clinic at a participating organization 2. Provides care to children with AOM 3. Administrative or local approval for participation

B. Secondary Electronic Health Record Data

1. Aged 6 months-17-years-old (inclusive)

2. Diagnosis of AOM by ICD10 code

C. Video recordings or direct observation of the use of a shared decision aid

Parent participation:

1. Child aged 6 months-17 years (inclusive)

2. Diagnosed with AOM by clinician

3. Parent or legal guardian is present and is >=18 years or older

Clinician Participation:

1. Licensed clinician and not a medical trainee

2. Age 18 >= years or older

D. Pre-implementation interviews of clinicians and administrators

1. Licensed clinician (physician or advanced practice clinician) that cares forchildren with AOM at a participating organization or an administrator/manager at aparticipating organization.

2. Aged >=18 years-no maximum

E. Pre-implementation focus groups of parents

1. Parent or legal guardian of a child aged 6 months-17 years (inclusive) that has hadAOM diagnosed at a participating organization.

2. 18 years of age or older and able/willing to consent

F. Parents enrolled for surveys

1. Parent or legal guardian of a child aged 6 months-17 years (inclusive) that has hadAOM diagnosed at a participating organization. 2. Willing to participate and able tocomplete electronic surveys at enrollment and 10 days after enrollment. 3. Workingphone 4. Age >=18 years of age

G. Post-intervention focus groups of parents

1. Parent or legal guardian of a child aged 6 months-17 years (inclusive) that has hadAOM diagnosed at a participating organization.

2. 18 years of age or older and able/willing to consent

H. Post-intervention surveys of clinicians and administrators

1. Licensed clinician (physician or advanced practice clinician) that cares forchildren with AOM at a participating organization or an administrator/manager at aparticipating organization.

2. Aged >=18 years-no maximum

Exclusion Criteria:

A. Implementation of Interventions

1. Clinics that exclusively provide telehealth

B. Secondary Electronic Health Record Data

1. None

C. Video recordings or direct observation of the use of a shared decision aid

Parent participation:

1. None

Clinician Participation:

1. None

D. Pre-implementation interviews of clinicians and administrators 1. Medical trainee (student, resident, fellow, etc.)

E. Pre-implementation focus groups of parents

1. None

F. Parents enrolled for surveys 1. Complicated or recurrent AOM as determined by the study team

G. Post-intervention focus groups of parents 1. None

H. Post-intervention surveys of clinicians and administrators

1. Medical trainee (student, resident, fellow, etc.)