Electronic health record feedback to improve antibiotic prescribing for acute respiratory infections.
Am J Manag Care
; 16(12 Suppl HIT): e311-9, 2010 Dec.
Article
en En
| MEDLINE
| ID: mdl-21322301
ABSTRACT
OBJECTIVE:
To examine whether the Acute Respiratory Infection (ARI) Quality Dashboard, an electronic health record (EHR)-based feedback system, changed antibiotic prescribing. STUDYDESIGN:
Cluster randomized, controlled trial.METHODS:
We randomly assigned 27 primary care practices to receive the ARI Quality Dashboard or usual care. The primary outcome was the intent-to-intervene antibiotic prescribing rate for ARI visits. We also compared antibiotic prescribing between ARI Quality Dashboard users and nonusers.RESULTS:
During the 9-month intervention, there was no difference between intervention and control practices in antibiotic prescribing for all ARI visits (47% vs 47%; P = .87), antibiotic-appropriate ARI visits (65% vs 64%; P = .68), or nonantibiotic-appropriate ARI visits (38% vs 40%; P = .70). Among the 258 intervention clinicians, 72 (28%) used the ARI Quality Dashboard at least once. These clinicians had a lower overall ARI antibiotic prescribing rate (42% vs 50% for nonusers; P = .02). This difference was due to less antibiotic prescribing for non-antibiotic-appropriate ARIs (32% vs 43%; P = .004), including nonstreptococcal pharyngitis (31% vs 41%; P = .01) and nonspecific upper respiratory infections (19% vs 34%; P = .01).CONCLUSIONS:
The ARI Quality Dashboard was not associated with an overall change in antibiotic prescribing for ARIs, although when used, it was associated with improved antibiotic prescribing. EHR-based quality reporting, as part of "meaningful use," may not improve care in the absence of other changes to primary care practice.
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Bases de datos:
MEDLINE
Asunto principal:
Infecciones del Sistema Respiratorio
/
Pautas de la Práctica en Medicina
/
Sistemas de Apoyo a Decisiones Clínicas
/
Registros Electrónicos de Salud
/
Antibacterianos
Tipo de estudio:
Clinical_trials
/
Prognostic_studies
Límite:
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2010
Tipo del documento:
Article
País de afiliación:
Estados Unidos