Clinical Decision Support Tools for Antibiotic Prescribing

Study Overview
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Brief Summary
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The goal of this study is to assess the utility of a data visualization tool for providers' understanding patients' past microbiological culture sensitivities. Providers that are ordering antibiotics for patients with previous culture data in the medical record will be asked to answer questions regarding past sensitivity results. They will be randomized to either using the visualization tool before answering the questions or using the standard medical record tools. They will then be surveyed about their decision-making, knowledge, and the usefulness of the tool.

Official Title
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The Effect of Data Visualization on Provider Knowledge of Culture Sensitivity Results

Conditions
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Infectious Disease

Intervention / Treatment
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* Other: Visualization tool


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: provider is caring for a patient with a previous positive urine or blood cultures provider is caring for a patient currently in a clinical location being investigated provider is caring for a patient with orders placed for an intravenous, intramuscular, oral antibiotics Exclusion Criteria: the patient has already received the antibiotic by the time of the intervention the antibiotic has been cancelled by the time of intervention the research assistant is unable to reach the ordering provider before the visit is completed participation by the clinician in the study would impede clinical care age < 18

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Antibiotic visualization tool<br>Provider will answer microbiological sensitivity questions using a new antibiotic visualization tool. | Other: Visualization tool<br>* Visual representation of past microbiological culture data<br>|
| No Intervention: Standard practice<br>Provider will answer microbiological sensitivity questions using standard medical record tools. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Provider knowledge | Provider knowledge of patients' previous culture sensitivity results as determined by the proportion of correct answers on a questionnaire: Do you think this patient has had previous resistance to each of these antibiotics at BIDMC (Beth Israel Deaconess Medical Center)? [List of the top 4 antibiotic classes to which resistance is seen at BIDMC that the patient has previously had tested for antibiotic sensitivities] Yes (previous organisms resistant or with intermediate resistance) No (no previous resistance noted) | To be assessed at the time of patient enrollment, up to one day after the initial antibiotic is ordered. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-intervention survey | Providers will be asked survey questions regarding their decision-making and the usability and usefulness of the tool using a 5 point Likert scale: I understand the previous culture data for this patient (Strongly disagree) 1 2 3 4 5 (Strongly agree) I feel like I made an informed antibiotic choice (Strongly disagree) 1 2 3 4 5 (Strongly agree) The tool provided new information that you were not previously aware of (Strongly disagree) 1 2 3 4 5 (Strongly agree) The tool enabled you to more quickly understand this patient's microbiological data (Strongly disagree) 1 2 3 4 5 (Strongly agree) The tool was easy to use (Strongly disagree) 1 2 3 4 5 (Strongly agree) | To be assessed at the time of patient enrollment, up to one day after the initial antibiotic is ordered. | 
| Antibiotic order changes | Antibiotic orders that are not complete by the time of the intervention will be monitored for any cancellation or change in orders | To be assessed at the time of patient enrollment + 1 day | 
| Final culture results | Final culture results drawn from that visit will be compared to antibiotic orders for effectiveness | To be assessed at the time of patient enrollment + 1 week |