title: Electronic health record feedback to improve antibiotic prescribing for acute respiratory infections.
abstract: OBJECTIVE
  To examine whether the Acute Respiratory Infection (ARI) Quality Dashboard, an electronic health record (EHR)-based feedback system, changed antibiotic prescribing.
  
  
  METHODS
  Cluster randomized, controlled trial.
  
  
  METHODS
  We randomly assigned 27 primary care practices to receive the ARI Quality Dashboard or usual care. The primary outcome was the intent-to-intervene antibiotic prescribing rate for ARI visits. We also compared antibiotic prescribing between ARI Quality Dashboard users and nonusers.
  
  
  RESULTS
  During the 9-month intervention, there was no difference between intervention and control practices in antibiotic prescribing for all ARI visits (47% vs 47%; P = .87), antibiotic-appropriate ARI visits (65% vs 64%; P = .68), or non–antibiotic-appropriate ARI visits (38% vs 40%; P = .70). Among the 258 intervention clinicians, 72 (28%) used the ARI Quality Dashboard at least once. These clinicians had a lower overall ARI antibiotic prescribing rate (42% vs 50% for nonusers; P = .02). This difference was due to less antibiotic prescribing for non-antibiotic-appropriate ARIs (32% vs 43%; P = .004), including nonstreptococcal pharyngitis (31% vs 41%; P = .01) and nonspecific upper respiratory infections (19% vs 34%; P = .01).
  
  
  CONCLUSIONS
  The ARI Quality Dashboard was not associated with an overall change in antibiotic prescribing for ARIs, although when used, it was associated with improved antibiotic prescribing. EHR-based quality reporting, as part of "meaningful use," may not improve care in the absence of other changes to primary care practice.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA. jlinder@partners.org
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
authors.forename: Ruslana
authors.initials: R
authors.lastname: Tsurikova
authors.forename: D Tony
authors.initials: DT
authors.lastname: Yu
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Melnikas
authors.forename: Matvey B
authors.initials: MB
authors.lastname: Palchuk
authors.forename: Maya
authors.initials: M
authors.lastname: Olsha-Yehiav
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016000:Cluster Analysis; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006801:Humans; D008404:Massachusetts; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents