Study Finds Use of CPR Tool Reduces Use of Antibiotics

A new randomized clinical trial found that the use of an integrated clinical prediction rule (CPR) tool reduced the use of antibiotics and resulted in less rapid streptococcal tests compared to those providers in the control group. The results of the study were recently published in JAMA Internal Medicine [2013;173(17):1584-1591.doi:10.1001/jamainternmed.2013.8980].

Overtreatment and testing can lead to unnecessary medical care and expenses within the US healthcare system. However, clinical decision support (CDS) tools that have been integrated into electronic health records (EHR) have been suggested as a way to reduce this unnecessary care and spending.

"It has real potential if done correctly to reduce a lot of waste," said Thomas McGinn, MD, MPH, lead researcher of the study, chair of medicine at the North Shore-LIJ Health System, during an interview with First Report Managed Care.

In this study, researchers examined the effect of integrated CPR tools in the treatment of upper respiratory tract infections and hoped to improve their adoption among 168 providers in real-time care settings.

In the randomized clinical trial, providers in 2 large urban ambulatory primary care practices were randomized to either a control or intervention group. Those in the intervention group participated in a 1-hour training that provided them with evidence supporting the CPRs, demonstration of how the tool is used in the EHR, and a simulation video of its use in a clinical setting.

During the study period from November 1, 2010 to October 31, 2011, whenever a provider in the intervention group would enter 1 of the previously identified keywords into the record, the CPR tool would pop up. Providers could then choose whether to complete the risk score calculator, order medications, or generate progress notes to aid in patient care management.

Dr. McGinn said 1 of the key aspects of the CPR tool was that it only triggered when necessary, or in about 3% of the more than 40,003 patient visits that occurred during the study period. "We monitored the trigger rate very carefully," he said.

The primary outcome of the study was identified as changes to provider patterns of ordering antibiotics.

Researchers found that those providers in the intervention group were significantly less likely to order antibiotics than those in the control group (age adjusted relative risk [RR], 0.74; 95% confidence interval [CI], 0.60-0.92; P=.008).

They also noted that providers in the intervention group were less likely to order a rapid streptococcal test for those presenting with pharyngitis symptoms, but there was no significant difference between the study groups for chest radiograph orders for patients presenting with pneumonia symptoms.

In terms of provider adoption of the tools, researchers reported that, overall, 57.5% of providers accepted the tool in the intervention group once it had been triggered. They did, however, find that the pharyngitis tool was used more often compared to the pneumonia tool.

According to the data, the pharyngitis tool was accepted 74.3% of the time it was triggered, while the pneumonia tool was accepted just 42.5% of the time it was triggered (RR, 0.65; 95% CI, 0.54-0.78; P<.001).

Providers were also more likely to complete more steps of the pharyngitis tool.