Acute Respiratory Infection
Conditions
Brief summary
This study evaluates the effects of a novel integrated clinical prediction tool on antibiotic prescription patterns of nurses for acute respiratory infections (ARIs). The intervention is an EHR-integrated risk calculator and order set to help guide appropriate, evidence-based antibiotic prescriptions for patients presenting with ARI symptoms.
Detailed description
The proposed project will fill a critical gap in the evidence base and answer the important question: can pivoting ARI CDS tools towards nurses overcome established implementation barriers to reducing antibiotic use? The proposal is highly innovative in three ways: It uses CDS tools to embed evidence-based risk stratification to enable nurse-led ARI management. It creates a nurse training program to support this nurse-led ARI treatment pathway. It will be evaluated and optimized using evidence-based implementation frameworks that will guide assessment of the fidelity, acceptability, adoption, cost, and sustainability of the tool. This will provide comprehensive implementation measures, formative and summative, and enable a rigorous understanding of barriers and facilitators to implementing nurse-led CDS tools for reducing antibiotic overprescribing. This study will provide much needed guidance on how to implement CDS-enabled, nurse-led ARI assessment and treatment to reduce antibiotic overprescribing.
Interventions
OTHERIntegrated clinical prediction rule (iCPR) system (iCPR)
The iCPR tool consists of an electronic calculator that can be used to determine whether the patient is at low, intermediate or high risk for having the diagnosis and a bundled order set (called a Smartset). The iCPR tool will be made available directly within the Electronic Health Record (EHR) for Registered Nurses (RNs) who are seeing patients fall into the study categories. The iCPR tool through the use of order sets will guide the RN in the patient's care. The order set for patients at low risk for these diseases will recommend supportive care including over the counter cold remedies and pain relievers. The order set for patients at intermediate or high risk of these disease will recommend diagnostic tests (rapid strep antigen or CXR) to help determine if they have the disease. Based on the results of the diagnostic tests new order sets will recommend antibiotics or supportive care
Sponsors
National Institute of Allergy and Infectious Diseases (NIAID)
NYU Langone Health
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Clinics: * must be primary care and/or urgent care clinics * should have a minimum of one registered nurse (RN) full time equivalents (FTE) Nurses : * be licensed to see patients and prescribed and/or recommend prescriptions for patients * work a minimum of 0.5 FTE to ensure that they are seeing sufficient numbers of patients to maintain competency * have access to the clinic EHR system, and use regularly as part of patient care Patients: * patients must have been seen at a participating clinic with a complaint of cough or sore throat. * Ages 3-70 will be included for sore throat and ages 18-70 for cough
Exclusion criteria
* are unable or unwilling to provide informed consent * are unable to participate meaningfully in an intervention that involves self-monitoring using software available in English (e.g., due to uncorrected sight impairment, illiterate, non-English-speaking, dementia) * clinics will be excluded if phone call triage of patients with sore throat and cough is not performed by RNs * Nurses will be excluded if they do not work with the clinic EHR as part of their workflow * Patients with a history of chronic lung disease or immunosuppression will be excluded since the CPRs were not validated in these groups
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Perceive the iCPR Tool as Useful. | Month 6 | Participants will be interviewed to measure the usefulness of the iCPR tool in prescribing appropriate antibiotics. |
| Change in proportion of Acute Respiratory Infection (ARI) encounters with inappropriate antibiotic prescribing | Baseline, Month 36 | The number of Acute Respiratory Infection (ARI) encounters with inappropriate antibiotic prescription will be measured pre and post-intervention using EHR reports assessing ordering of antibiotics |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Job Satisfaction of RNs and physicians | Baseline, Month 6 | Job satisfaction/ burnout of the RNs and physicians in enrolled clinics will be measured qualitatively with interviews at baseline, 6, and 12 months after implementation |
| Number of nurse triage encounters completed | Week 2 | Adoption of using iCPR tool will be measured by the number of nurse triage encounters completed through extracted EHR data. |
| Number of patients requiring repeat healthcare visits | week 2 | Adoption of using iCPR tool will be measured by the number of patients requiring repeat healthcare visits through extracted EHR data. |
Countries
United States
Outcome results
None listed