Consent

SCORE-UC: Improving Antibiotic Use in Urgent Care Facilities Through Implementation
And Evaluation of Core Elements of Outpatient Antibiotic Stewardship
PI: Eddie Stenehjem, MD MSc

Version Date: 9/13/2019
Version: 3

Consent Cover Letter
Study Title: SCORE - UC: Improving Antibiotic Use in Urgent Care Facilities
Through Implementation and Evaluation of Core elements of
Outpatient Antibiotic Stewardship
Principal Investigators: Eddie Stenehjem, MD MSc/ Adam Hersh MD PhD
The purpose of this research is to pair clinical effectiveness researchers with
implementation science researchers in order to conduct a study implementing
evidence-based practices of appropriate antibiotic prescribing in the Urgent (UC)
setting. The specific aims are to perform a retrospective evaluation of antibiotic
prescription practices in Intermountain Healthcare UCs and evaluate the impact of
implementing antibiotic stewardship best practices into the UC setting.
We would like you to participate in a semi-structured interview, so we may be
able to determine the barriers and facilitators to appropriate antibiotic prescribing in
the Urgent Care setting. This semi-structured interview should take up to 20
minutes depending on your answers. This semi-structured interview will be
recorded and transcribed for the purposes of the study.
Only authorized members of the study team may view the collected data.
Information that would identify you directly will not be collected.
If you have any questions complaints or if you feel you have been harmed by this
research, please contact Dr. Eddie Stenehjem (801) 507-7781
([email protected]).
If you have questions regarding your rights as a research subject or if problems
arise which you do not feel you can discuss with the Investigator, please contact
Intermountain’s Office of Research at 1-800-321-2107.
Participation in this study is voluntary. You can choose not to take part. The only
potential risk is the potential for breach of confidentiality. Your responses will be
de-identified and individual identification will not be reported to others. There is no
benefit to you for participating.
By agreeing to participate in the semi-structured interview, you are giving your
consent to participate.
We thank you for your time and your willingness to participate in this research study.

Intermountain Healthcare IRB
IRB NUMBER: 1050982
IRB APPROVAL DATE: 09/18/2019
IRB EXPIRATION DATE: 09/17/2020