The DOI matches its Crossref record; 2 of the 2 references it cites were found in a registry or an index.
Impact of Clinical Decision Support on Antibiotic Prescribing for Acute Respiratory Infections: a Cluster Randomized Implementation Trial
Open accessAbstract
Background Clinical decision support (CDS) is a promising tool for reducing antibiotic prescribing for acute respiratory infections (ARIs). Objective To assess the impact of previously effective CDS on antibiotic-prescribing rates for ARIs when adapted and implemented in diverse primary care settings. Design Cluster randomized clinical trial (RCT) implementing a CDS tool designed to guide evidence-based evaluation and treatment of streptococcal pharyngitis and pneumonia. Setting Two large academic health system primary care networks with a mix of providers. Participants All primary care practices within each health system were invited. All providers within participating clinic were considered a participant. Practices were randomized selection to a control or intervention group. Interventions Intervention practice providers had access to an integrated clinical prediction rule (iCPR) system designed to determine the risk of bacterial infection from reason for visit of sore throat, cough, or upper respiratory infection and guide evidence-based evaluation and treatment. Main outcome(s) Change in overall antibiotic prescription rates. Measure(s) Frequency, rates, and type of antibiotics prescribed in intervention and controls groups. Results 33 primary care practices participated with 541 providers and 100,573 patient visits. Intervention providers completed the tool in 6.9% of eligible visits. Antibiotics were prescribed in 35% and 36% of intervention and control visits, respectively, showing no statistically significant difference. There were also no differences in rates of orders for rapid streptococcal tests (RR, 0.94; P = 0.11) or chest X-rays (RR, 1.01; P = 0.999) between groups. Conclusions The iCPR tool was not effective in reducing antibiotic prescription rates for upper respiratory infections in diverse primary care settings. This has implications for the generalizability of CDS tools as they are adapted to heterogeneous clinical contexts. Trial registration Clinicaltrials.gov (NCT02534987). Registered August 26, 2015 at https://clinicaltrials.gov.
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Adoption of CDS has been studied across a wide range of clinical applications.
“Adoption of CDS has been studied across a wide range of clinical applications 24,51 .”
From Factors driving provider adoption of the TREWS machine learning-based early warning system and its effects on sepsis treatment timing (2022) · cites this paper as [24]
The Introduction says the trial studied CDS adoption for two target conditions, pneumonia and streptococcal pharyngitis. The Discussion describes prior studies with varied CDS tools and adoption rates, but does not establish that adoption has been studied across a wide range of clinical applications. Page numbers are not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe lack of adoption typically translates to low to moderate impact on clinical processes.
“As expected, the lack of adoption typically translates to low to moderate impact on clinical processes 24,51 .”
From Factors driving provider adoption of the TREWS machine learning-based early warning system and its effects on sepsis treatment timing (2022) · cites this paper as [24]
The Process Outcomes section reports low tool adoption, and the Discussion says that low utilization may explain the absence of an effect on antibiotic prescribing. The Introduction also describes other trials with low adoption and no change in prescribing. These passages support a limited-impact connection for antibiotic prescribing in acute respiratory infections, but not the broader claim that lack of adoption typically produces low-to-moderate effects across clinical processes. Page numbers were not available in our copy. (LLM, conf=0.85)
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Citations
Cites
Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011
Fleming-Dutra, K. E., Hersh, A. L., Shapiro, D. J., Bartoces, M., Enns, E. A., File, T. M., Finkelstein, J. A., Gerber, J. S., Hyun, D. Y., Linder, J. A., et al. (2016) · JAMA · doi:10.1001/jama.2016.4151 · Cited by 1,740
with the HITEC Investigators, Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-017-0430-8 · Cited by 709
Flagged first, then by citations
Research works printed but not linked: 22
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Cited by
Sorted by citations
Henry, K. E., Adams, R., Parent, C., Soleimani, H., Sridharan, A., Johnson, L., Hager, D. N., Cosgrove, S. E., Markowski, A., Klein, E. Y., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-01895-z · Cited by 144
Metadata
- Authors
- Mann, D., Hess, R., McGinn, T., Richardson, S., Jones, S., Palmisano, J., Chokshi, S. K., Mishuris, R., McCullagh, L., Park, L., Dinh-Le, C., Smith, P., & Feldstein, D.
- Affiliations
- NYU Langone Health (US)
- University of Utah (US)
- Hofstra University (US)
- New York University (US)
- Boston University (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Mann, Devin
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2020-09-01
- Volume
- 35
- Issue
- S2
- Pages
- 788-795
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC7652959
- OpenAlex
- W3081646668
- Cited by
- 27
- References
- 2
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 1 · 2020: 1
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (R01AI108680)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- clinical decision support, antibiotic prescribing, acute respiratory infections, streptococcal pharyngitis, pneumonia, upper respiratory tract infection, sore throat, chest radiography, primary care, implementation, generalizability
- MeSH terms
- Anti-Bacterial Agents, Humans, Practice Patterns, Physicians', Primary Health Care, Respiratory Tract Infections, Decision Support Systems, Clinical
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