sábado, 30 de abril de 2011

Electronic health record feedback to improve antib... [Am J Manag Care. 2010] - PubMed result

Am J Manag Care. 2010 Dec;16(12 Suppl HIT):e311-9.

Electronic health record feedback to improve antibiotic prescribing for acute respiratory infections.

Linder JA, Schnipper JL, Tsurikova R, Yu DT, Volk LA, Melnikas AJ, Palchuk MB, Olsha-Yehiav M, Middleton B.

Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA
. jlinder@partners.org

OBJECTIVE: To examine whether the Acute Respiratory Infection (ARI) Quality Dashboard, an electronic health record (EHR)-based feedback system, changed antibiotic prescribing.

STUDY DESIGN: Cluster randomized, controlled trial.

METHODS: We randomly assigned 27 primary care practices to receive the ARI Quality Dashboard or usual care. The primary outcome was the intent-to-intervene antibiotic prescribing rate for ARI visits. We also compared antibiotic prescribing between ARI Quality Dashboard users and nonusers.

RESULTS: During the 9-month intervention, there was no difference between intervention and control practices in antibiotic prescribing for all ARI visits (47% vs 47%; P = .87), antibiotic-appropriate ARI visits (65% vs 64%; P = .68), or non–antibiotic-appropriate ARI visits (38% vs 40%; P = .70). Among the 258 intervention clinicians, 72 (28%) used the ARI Quality Dashboard at least once. These clinicians had a lower overall ARI antibiotic prescribing rate (42% vs 50% for nonusers; P = .02). This difference was due to less antibiotic prescribing for non-antibiotic-appropriate ARIs (32% vs 43%; P = .004), including nonstreptococcal pharyngitis (31% vs 41%; P = .01) and nonspecific upper respiratory infections (19% vs 34%; P = .01).

CONCLUSIONS: The ARI Quality Dashboard was not associated with an overall change in antibiotic prescribing for ARIs, although when used, it was associated with improved antibiotic prescribing. EHR-based quality reporting, as part of "meaningful use," may not improve care in the absence of other changes to primary care practice.

PMID:21322301[PubMed - in process]
Electronic health record feedback to improve antib... [Am J Manag Care. 2010] - PubMed result

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