Demonstration of Near Zero Antibiotic Prescribing for Acute Bronchitis

Overview

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.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Health Services Research
    • Masking: None (Open Label)
  • Study Primary Completion Date: June 2014

Detailed Description

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.

Interventions

  • Behavioral: Demonstration of near zero antibiotic prescribing for patients with acute bronchitis
    • A controlled, continuously-monitored, implementation of an EHR-integrated diagnosis and treatment algorithm for acute bronchitis in a large, diverse primary care practice.

Arms, Groups and Cohorts

  • Other: Intervention Arm
    • Single arm in the study of doctors receiving feedback about their antibiotic prescribing rate for acute bronchitis.

Clinical Trial Outcome Measures

Primary Measures

  • Antibiotic prescribing rate
    • Time Frame: 30 days
    • The antibiotic prescribing rate for patients with acute bronchitis

Secondary Measures

  • Patient symptoms
    • Time Frame: 21 days
  • Patient satisfaction
    • Time Frame: 21 days
  • Patient safety
    • Time Frame: 30 days
  • Healthcare costs
    • Time Frame: 30 days
  • The capture and description of the components that had the greatest effect on the antimicrobial prescribing rate
    • Time Frame: 3 years

Participating in This Clinical Trial

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

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 64 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Brigham and Women’s Hospital
  • Collaborator
    • Agency for Healthcare Research and Quality (AHRQ)
  • Provider of Information About this Clinical Study
    • Principal Investigator: Jeffrey A. Linder, Associate Physician – Brigham and Women’s Hospital
  • Overall Official(s)
    • Jeffrey A Linder, MD, MPH, Principal Investigator, Brigham and Women’s Hospital, Harvard Medical School

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