Summaries of Independent Scientist (K) Awards

Cox, Elizabeth D.

Institution: University of Wisconsin Madison
Grant Title: Shared Decision-Making and Inappropriate Antibiotic Use
Grant Number:  K08 HS13183
Duration: 5 years (2002-2007)
Total Award: $578,000

Project Description: This grant has been completed. The project planned to develop and validate an instrument to measure shared decisionmaking in pediatric primary care to examine the relationship of shared decisionmaking to quality of care outcomes for children's upper respiratory infections. The candidate hypothesized that shared decisionmaking in acute primary care visits for upper respiratory infection would decrease inappropriate antibiotic prescribing, while providing satisfaction for both the parent and patient.

Career Goals: Dr. Cox is an Assistant Professor in the Department of Pediatrics in the School of Medicine and Public Health, at University of Wisconsin, Madison. She received her MD from West Virginia University and served her residency in Pediatrics at the University of Wisconsin. She went on to earn her PhD in Health Services Research, also at the University of Wisconsin. Dr. Cox continues conducting health services research in doctor-patient communication, with a focus on the use of shared decision-making to improve quality of care for children.

Progress to Date: This research produced three necessary validated measures for assessing participation in key decision-making tasks in pediatric upper respiratory infection (URI) visits—tools for assessing the physician-parent relationship, the deliberation process in the visit, and the discussion of alternatives, risks and benefits.Application of these measures has added significantly to our understanding of child, patent, and physician participation during pediatric health care visits. Further, the results suggested several common factors that may impact our ability to foster participation in pediatric primary care visits. Examination of these factors should facilitate identification and targeting of interventions to support participation in decision-making. In addition, the work has produced a reliable method of assessing bacterial URI diagnoses from visit videotapes. The findings from this work suggest that physician-reporting diagnoses overestimate bacterial URIs and thus underestimate antibiotic over-prescribing. 

Highlights and Specific Accomplishments:

• Professional Societies:
  • Academy for Health Services Research and Health Policy.
  • American Academy of Pediatrics.
• Evaluating a Web-based curriculum for 3^rd year medical students.

K-Generated Publications (selected):

Cox ED, Smith MA, Brown RL, Fitzpatrick MA. Effect of gender and visit length on participation in pediatric visits. Patient Education and Counseling 2007. 65:320-28.

Smith MA, Cox ED, Bartell JM. Overprescribing in lipid lowering agents. Quality and Safety in Health Care 2006. 15:251-57

Koscik RL, Kokotailo PK, Cox ED. Medical student education: Addressing patient mental health needs. Medical Education 2005; 39(5):514.

Cox ED, Smith MA, Bartell JM. Managing febrile infants: Impact of literature published during a physician's residency. Evaluation and Health Professions 2005; 28:1-21.

Cox ED, Smith MA, Brown RL. Evaluating deliberation in pediatric primary care. Pediatrics 2007. 120(1):e68-77.

Cox ED, Smith MA, Brown RL, et al. Assessment of physician-caregiver relationship scales. Patient Education and Counseling 2008;70:69-78.

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