Bronchitis, Cough
Conditions
Keywords
Antibiotic, Antimicrobial, Prescribing, Cough, Acute Bronchitis
Brief summary
Studies show, guidelines state, and performance measures assert that antibiotic prescribing for uncomplicated acute bronchitis is inappropriate. However, clinicians prescribe antimicrobials in over 60% of the 22.5 million acute bronchitis visits in the United States each year. Previous successful interventions have only reduced the antimicrobial prescribing rate to 40% or 50%. It is unknown if the antimicrobial prescribing rate for acute bronchitis can be brought to near zero percent in actual practice while maintaining patient safety and satisfaction. The goal of this study is to develop an Electronic Health Record (EHR)-integrated algorithm for the diagnosis and treatment of adults with acute bronchitis with a goal of reducing the antibiotic prescribing rate to near zero percent.
Detailed description
We will use a multi-modal implementation - including computerized decision support, reporting tools, and clinician feedback - and quality improvement techniques to ensure adherence to the algorithm and reduce the antimicrobial prescribing rate to near zero percent. The duration of the intervention will be 4 years.
Interventions
BEHAVIORALDemonstration of near zero antibiotic prescribing for patients with acute bronchitis
A controlled, continuously-monitored, implementation of an EHR-integrated diagnosis and treatment algorithm for acute bronchitis in a large, diverse primary care practice.
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Brigham and Women's Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 64 Years
Healthy volunteers
Yes
Inclusion criteria
* first visit in 30 days, age 18-64, has a cough of less than 3 weeks duration
Exclusion criteria
* infiltrate on chest x-ray, has chronic lung disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Antibiotic prescribing rate | 30 days | The antibiotic prescribing rate for patients with acute bronchitis |
Secondary
| Measure | Time frame |
|---|---|
| Patient symptoms | 21 days |
| Patient satisfaction | 21 days |
| Patient safety | 30 days |
| Healthcare costs | 30 days |
| The capture and description of the components that had the greatest effect on the antimicrobial prescribing rate | 3 years |
Countries
United States
Outcome results
None listed