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
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.
C. Konchak, None
J. Fahrenbach, None
E. C. Brown, None
A. Robicsek, None