Brief Title
How Does the Clinical Tool 'What's Going Around' Affect Clinical Practice
Official Title
How Does the Clinical Tool 'What's Going Around' Affect Clinical Practice
Brief Summary
Previous work has shown that the epidemiological context of a patient's presentation can
provide important information for clinicians to aid in diagnosis and treatment. With current
electronic health records, it is increasingly possible to perform syndromic surveillance that
is local and specific to a patient's characteristics.
The investigators have developed algorithms for syndromic surveillance for a number of
conditions in which contextual information might be of use to treating clinicians. The
syndromic surveillance algorithms already developed are for influenza-like-illness, whooping
cough, asthma exacerbation, Group A Streptococcal pharyngitis, and gastroenteritis infection.
The investigators plan on studying these tools with a clustered randomized control cohort
study evaluating how clinical decision making is affected by use of these tools by outpatient
general practitioners. The goal is to incorporate these validated algorithms into a quality
improvement tool which will provide point-of-care clinical decision support to clinicians
Detailed Description
The epidemiological context of a patient's presentation can provide important information for
clinicians to aid in diagnosis and treatment. The investigators previously developed and
validated a syndromic surveillance tool for detecting influenza-like illness (ILI)
encounters. The investigators then evaluated 40,642 outpatient ILI episodes during 'flu
seasons' over 6 years. The investigators found that even after controlling for patient
presentation and physician factors, the context in which a patient presented was strongly
associated with the likelihood that an antimicrobial agent would be prescribed. Specifically,
patients were less likely to be prescribed an antibiotic if they presented with ILI during
the pandemic influenza period (when awareness of 'flu season' was very high), or after their
physician had personally seen many patients with ILI in the prior week.
Currently, most clinicians have only limited access to data regarding the 'context' in which
a patient presents. Under such circumstances, physicians are often unaware of local
epidemiological information that could help them make optimal treatment decisions. In centers
with advanced use of electronic health records (EHRs), it is increasingly possible to perform
syndromic surveillance that is local (e.g. specific to a neighborhood or school district),
current (e.g. updated daily), and specific to a patient's characteristics (e.g. age, chief
complaint).
To that end, the investigators have developed algorithms for syndromic surveillance for a
number of syndromes including Asthma, ILI, Pertussis, Group A Streptococcus Pharyngitis, and
Gastroenteritis. These algorithms may provide contextual information that might be of use to
clinicians.
The purpose of this study is to determine the effect of how a point-of-care clinical decision
tool in the form of syndromic surveillance algorithms affect clinical decision making amongst
outpatient health care providers and also patient outcomes. We will be using a 2 year look
back prior to tool roll out as a comparison.
Specific Aims:
To determine the effect this point-of-care clinical decision tool has on clinical decision
making amongst primary care providers.
To determine the clinical outcomes of patients whose physicians had access to these tools
To understand how these point-of-care clinical decision tools are used among healthcare
providers in day to day practice
Study Type
Interventional
Primary Outcome
Percentage of visits for ILI in which a patient was prescribed an antibacterial agent during the seasonal flu season
Secondary Outcome
Percentage of visits for ILI in which a patient was prescribed an antiviral agent during the seasonal flu season
Condition
Influenza Like Illness
Intervention
What's Going Around tool
Study Arms / Comparison Groups
Control
Description: Providers do not have access to What's Going Around Tool but receive an instructional video explaining tool
Publications
* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
Recruitment Information
Recruitment Status
Other
Estimated Enrollment
206703
Start Date
November 2013
Completion Date
November 2014
Primary Completion Date
November 2014
Eligibility Criteria
Inclusion Criteria:
All patients seen in a Northshore University HealthSystem outpatient clinic (Family
Medicine, Internal Medicine or Pediatric) between the Nov 1 2013 to Oct 31 2014
Exclusion Criteria:
None
Gender
All
Ages
N/A - N/A
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Contacts
Ari Robicsek, MD, ,
Location Countries
United States
Location Countries
United States
Administrative Informations
NCT ID
NCT01979588
Organization ID
What's Going Around
Responsible Party
Principal Investigator
Study Sponsor
NorthShore University HealthSystem
Study Sponsor
Ari Robicsek, MD, Principal Investigator, NorthShore University HealthSystem
Verification Date
March 2016