Demonstration of Near Zero Antibiotic Prescribing for Acute Bronchitis

Study Overview
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Brief Summary
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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
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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.

Official Title
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Demonstration of Near Zero Antibiotic Prescribing for Acute Bronchitis

Conditions
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Bronchitis, Cough

Intervention / Treatment
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* Behavioral: Demonstration of near zero antibiotic prescribing for patients with acute bronchitis


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Intervention Arm<br>Single arm in the study of doctors receiving feedback about their antibiotic prescribing rate for acute bronchitis. | Behavioral: Demonstration of near zero antibiotic prescribing for patients with acute bronchitis<br>* A controlled, continuously-monitored, implementation of an EHR-integrated diagnosis and treatment algorithm for acute bronchitis in a large, diverse primary care practice.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Antibiotic prescribing rate | The antibiotic prescribing rate for patients with acute bronchitis | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cough, Antibiotic, Antimicrobial, Prescribing, Acute Bronchitis