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| ID | Type | Description | Link |
|---|---|---|---|
| 2R01AI108680-07A1 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Allergy and Infectious Diseases (NIAID) | NIH |
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This study evaluates the effects of a novel integrated clinical prediction tool on antibiotic prescription patterns of nurses for acute respiratory infections (ARIs). The intervention is an EHR-integrated risk calculator and order set to help guide appropriate, evidence-based antibiotic prescriptions for patients presenting with ARI symptoms.
The proposed project will fill a critical gap in the evidence base and answer the important question: can pivoting ARI CDS tools towards nurses overcome established implementation barriers to reducing antibiotic use? The proposal is highly innovative in three ways: It uses CDS tools to embed evidence-based risk stratification to enable nurse-led ARI management. It creates a nurse training program to support this nurse-led ARI treatment pathway. It will be evaluated and optimized using evidence-based implementation frameworks that will guide assessment of the fidelity, acceptability, adoption, cost, and sustainability of the tool. This will provide comprehensive implementation measures, formative and summative, and enable a rigorous understanding of barriers and facilitators to implementing nurse-led CDS tools for reducing antibiotic overprescribing. This study will provide much needed guidance on how to implement CDS-enabled, nurse-led ARI assessment and treatment to reduce antibiotic overprescribing.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| iCPR group | Experimental | Clinic personnel (Providers and Nurses) will receive online training that includes: 1) an overview of the project; 2) iCPR workflows including triage; 3) CPR component review and risk categories; 4) history and physical examination components of the CPRs. The online training will be followed by in-person training to reinforce the online training and teach additional skills. In-person training sessions led by study team will last approximately 60 minutes, and consist of four basic components: 1) a review of the iCPR ARI protocol and tools; 2) on-screen walk-throughs of common scenarios employing the new tools; 3) physical examination technique practice with simulated patients; A 60-minute in-person follow-up nurse training will take place 4-6 weeks after implementation of the intervention. |
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| Control no intervention group | No Intervention | standard care will continue as usual. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Integrated clinical prediction rule (iCPR) system (iCPR) | Other | The iCPR tool consists of an electronic calculator that can be used to determine whether the patient is at low, intermediate or high risk for having the diagnosis and a bundled order set (called a "Smartset"). The iCPR tool will be made available directly within the Electronic Health Record (EHR) for Registered Nurses (RNs) who are seeing patients fall into the study categories. The iCPR tool through the use of order sets will guide the RN in the patient's care. The order set for patients at low risk for these diseases will recommend supportive care including over the counter cold remedies and pain relievers. The order set for patients at intermediate or high risk of these disease will recommend diagnostic tests (rapid strep antigen or CXR) to help determine if they have the disease. Based on the results of the diagnostic tests new order sets will recommend antibiotics or supportive care |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants Who Perceive the iCPR Tool as Useful. | Participants will be interviewed to measure the usefulness of the iCPR tool in prescribing appropriate antibiotics. | Month 6 |
| Change in proportion of Acute Respiratory Infection (ARI) encounters with inappropriate antibiotic prescribing | The number of Acute Respiratory Infection (ARI) encounters with inappropriate antibiotic prescription will be measured pre and post-intervention using EHR reports assessing ordering of antibiotics | Baseline, Month 36 |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Job Satisfaction of RNs and physicians | Job satisfaction/ burnout of the RNs and physicians in enrolled clinics will be measured qualitatively with interviews at baseline, 6, and 12 months after implementation | Baseline, Month 6 |
| Change in Job Satisfaction of RNs and physicians |
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Inclusion Criteria:
Clinics:
Nurses :
Patients:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Devin Mann, MD | NYU Langone Health | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| NYU Langone Health | New York | New York | 10016 | United States | ||
| University of Utah School of Medicine |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39964400 | Derived | Dauber-Decker KL, Feldstein D, Hess R, Mann D, Kim EJ, Gautam-Goyal P, Solomon J, Khan S, Malik F, Xu L, Huffman A, Smith PD, Halm W, Yuroff A, Richardson S. Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study. JMIR Form Res. 2025 Feb 18;9:e55316. doi: 10.2196/55316. | |
| 38781006 | Derived | Stevens ER, Xu L, Kwon J, Tasneem S, Henning N, Feldthouse D, Kim EJ, Hess R, Dauber-Decker KL, Smith PD, Halm W, Gautam-Goyal P, Feldstein DA, Mann DM. Barriers to Implementing Registered Nurse-Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study. JMIR Form Res. 2024 May 23;8:e54996. doi: 10.2196/54996. |
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Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices).
Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.
Upon reasonable request. Requests should be directed to devin.mann@nyulangone.org. To gain access, data requestors will need to sign a data access agreement. The investigator who proposed to use the data.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| ICF | No | No | Yes | Informed Consent Form | Aug 15, 2022 | Feb 27, 2025 |
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Job satisfaction/ burnout of the RNs and physicians in enrolled clinics will be measured qualitatively with interviews at baseline, 6, and 12 months after implementation |
| Month 6, Month 12 |
| Number of nurse triage encounters completed | Adoption of using iCPR tool will be measured by the number of nurse triage encounters completed through extracted EHR data. | Week 2 |
| Number of patients requiring repeat healthcare visits | Adoption of using iCPR tool will be measured by the number of patients requiring repeat healthcare visits through extracted EHR data. | week 2 |
| Salt Lake City |
| Utah |
| 84112 |
| United States |
| University of Wisconsin | Madison | Wisconsin | 53705 | United States |
| 37964232 | Derived | Stevens ER, Agbakoba R, Mann DM, Hess R, Richardson SI, McGinn T, Smith PD, Halm W, Mundt MP, Dauber-Decker KL, Jones SA, Feldthouse DM, Kim EJ, Feldstein DA. Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial. BMC Med Inform Decis Mak. 2023 Nov 14;23(1):260. doi: 10.1186/s12911-023-02368-0. |
| ICF_000.pdf |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Jun 15, 2026 |
| ID | Term |
|---|---|
| D016503 | Drug Delivery Systems |
| ID | Term |
|---|---|
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
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