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What’s Going Around? A prospective cluster randomized trial to evaluate a novel, real-time, syndromic surveillance tool’s effect on clinical decision making amongst primary care providers

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background: A patient's epidemiological context can aid clinical decision making. NorthShore University HealthSystem is evaluating a novel, real-time, local, syndromic surveillance tool.

Methods:  The What's Going Around (WGA) tool collects data daily from electronic health records (EHR), processes the data through algorithms and generates a syndromic heatmap for Influenza-like-illness (ILI), Pertussis, Group A Strep (GAS) and pediatric asthma.  WGA provides these maps to clinicians inside their EHR (Figure).  A prospective cluster randomized trial is underway to evaluate this tool. 54 primary care practices were randomized to the WGA tool or control arms. A five month (11/1/13-4/1/14) interim analysis is being evaluated. The primary outcome is percentage of ILI visits with an antibiotic prescription. T tests and difference-in-differences (DID) calculations with a 2 year look back period were performed.

Results: The intervention arm did not prescribe fewer antibiotics for ILI visits than the control arm overall (41.1% vs 41.3%; p = 0.90). However, during periods of high and medium ILI activity, the intervention group experienced an absolute 2.0% and 5.1%* reduction in antibiotic prescription for ILI visits, (baseline 39.4% and 46.8%, respectively) and a 1.6% increase and 0.33%* decrease in antiviral prescription (9.7% and 2.4% baseline). For all clinic visits during periods of high and medium ILI activity there was an absolute 1.0%* and 1.7%* reduction in antibiotic prescription (baseline 21.1% and 19.1%).  During periods of high, medium and low pertussis, the intervention group had an absolute 2.2%* increase, a 1.4%* reduction and a 1.4%* reduction in pertussis PCR orders (baseline 8.6%, 7.8% and 6.3%, respectively). For high, medium and low GAS, the intervention group had an absolute 3.3%* increase, 8.4%* decrease and a 6.7%* decrease in GAS specific antibiotic prescriptions (baseline 46.3%, 46.2% and 40.9%, respectively). * Results significant at p<0.05 value.

Conclusion: This interim analysis suggests that an EHR-based decision support tool providing clinicians with local epidemiological information aids their decision making.

Nirav Shah, MD, MPH1, Jessica P. Ridgway, MD2, Chad Konchak3, John Fahrenbach, PhD4, Eric C. Brown, PhD3 and Ari Robicsek, MD5, (1)Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, (2)Infectious Diseases & Global Health, University of Chicago, Chicago, IL, (3)Northshore University Healthsystem, Evanston, IL, (4)Northshore University HealthSystem, Evanston, IL, (5)NorthShore University HealthSystem, Evanston, IL

Disclosures:

N. Shah, None

J. P. Ridgway, None

C. Konchak, None

J. Fahrenbach, None

E. C. Brown, None

A. Robicsek, None

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