Clinical trial NCT04255303: Decreasing Antibiotic Prescribing in Acute Respiratory Infections Through Nurse Driven Clinical Decision Support
Official title: Decreasing Antibiotic Prescribing in Acute Respiratory Infections Through Implementation of Nurse Driven Clinical Decision Support
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Acute Respiratory Infection
Lead sponsor: NYU Langone Health
Sponsor class: OTHER
Collaborators: name: National Institute of Allergy and Infectious Diseases (NIAID)
First posted: 2020-02-05
Enrollment: 347
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

Eligibility criteria: 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

Primary outcomes:
measure: Number of Participants Who Perceive the iCPR Tool as Useful.
timeFrame: Month 6
measure: Change in number of Acute Respiratory Infection(ARI) encounters
timeFrame: Baseline, Month 36
Secondary outcomes:
measure: Change in Job Satisfaction of RNs and physicians
timeFrame: Baseline, Month 6, Month 12
measure: Number of nurse triage encounters completed
timeFrame: Week 2
measure: Number of patients requiring repeat healthcare visits
timeFrame: week 2
Other outcomes:
Locations:
city: New York
country: United States
facility: NYU Langone Health
state: New York
city: Salt Lake City
country: United States
facility: University of Utah School of Medicine
state: Utah
city: Madison
country: United States
facility: University of Wisconsin
state: Wisconsin
Study officials:
affiliation: NYU Langone Health
name: Devin Mann, MD
role: PRINCIPAL_INVESTIGATOR
References: