Evidence map›Paper›PMID 37964232›Full record

ArticleBMC medical informatics and decision making2023

Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial.

Elizabeth R Stevens, Ruth Agbakoba, Devin M Mann, Rachel Hess, Safiya I Richardson, Thomas McGinn, Paul D Smith, Wendy Halm, Marlon P Mundt, Katherine L Dauber-Decker and 4 more

Registry-linked trialOpen access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medical informatics and decision making, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04255303 (Decreasing Antibiotic Prescribing in Acute Respiratory Infections Through Implementation of Nurse Driven Clinical Decision Support), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.1field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04255303 nacompletednot on this map

Decreasing Antibiotic Prescribing in Acute Respiratory Infections Through Implementation of Nurse Driven Clinical Decision Support

TypeinterventionalSponsorNYU Langone HealthRan2022 to 2025Enrolled347ConditionsAcute Respiratory InfectionArmsIntegrated clinical prediction rule (iCPR) system (iCPR)
3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 1 country.

Elizabeth R Stevens *NYU Grossman School of Medicine, New York, NY, USA.
Ruth Agbakoba *NYU Grossman School of Medicine, New York, NY, USA.
Devin M MannNYU Grossman School of Medicine, New York, NY, USA.
Rachel HessUniversity of Utah Health, Salt Lake City, UT, USA.
Safiya I RichardsonNYU Grossman School of Medicine, New York, NY, USA.
Thomas McGinnBaylor College of Medicine, Houston, TX, USA.
Paul D SmithUniversity of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Wendy HalmUniversity of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Marlon P MundtUniversity of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Katherine L Dauber-DeckerFeinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
Simon A JonesNYU Grossman School of Medicine, New York, NY, USA.
Dawn M FeldthouseNYU Grossman School of Medicine, New York, NY, USA.
Eun Ji KimFeinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
David A FeldsteinUniversity of Wisconsin School of Medicine and Public Health, Madison, WI, USA. df2@medicine.wisc.edu.
New York University · USUniversity of Wisconsin–Madison · USFeinstein Institute for Medical Research · USBaylor College of Medicine · USUniversity of Utah · US

Funding

Integrated Clinical Prediction Rules: Bringing Evidence to Diverse Primary Care SettingsR01AI108680 · NIAID · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI FELDSTEIN, DAVID ALAN, MANN, DEVIN M · 2014 to 2024
$7.9M
NIAID NIH HHS R01 AI108680
6 · The paper itself

Abstract

backgroundOverprescribing of antibiotics for acute respiratory infections (ARIs) remains a major issue in outpatient settings. Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model.

methodsFollowing qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested is: Implementation of RN-led iCPR tools will reduce antibiotic prescribing across diverse primary care settings. Specifically, this study aims to: (1) determine the impact of iCPRs on rapid strep test and chest x-ray ordering and antibiotic prescribing rates when used by RNs; (2) examine resource use patterns and cost-effectiveness of RN visits across diverse clinical settings; (3) determine the impact of iCPR-guided care on patient satisfaction; and (4) ascertain the effect of the intervention on RN and physician burnout. DISCUSSION: This study represents an innovative approach to using an iCPR model led by RNs and specifically designed to address inappropriate antibiotic prescribing. This study has the potential to provide guidance on the effectiveness of delegating care of low-acuity patients with ARIs to RNs to increase use of iCPRs and reduce antibiotic overprescribing for ARIs in outpatient settings.

trial registrationClinicalTrials.gov Identifier: NCT04255303, Registered February 5 2020, https://clinicaltrials.gov/ct2/show/NCT04255303 .

Indexed as

Decision Support Systems, ClinicalRespiratory Tract InfectionsAnti-Bacterial AgentsElectronic Health RecordsHumansNurse's RolePractice Patterns, Physicians'Randomized Controlled Trials as TopicAnti-Bacterial AgentsAcute respiratory infectionsAntibioticsEHRImplementationIntegrated clinical prediction rulesRCT

Identifiers

PMID37964232
PMCPMC10644670
OpenAlexW4388656964

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.