Study Results
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Basic Information
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COMPLETED
NA
1000 participants
INTERVENTIONAL
2004-02-29
2007-07-31
Brief Summary
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Detailed Description
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Specific Aim 1: To evaluate the impact of a multidimensional (patient, system, clinician) intervention on appropriate antibiotic use for adults with acute respiratory tract infections-- identifying factors that influence successful translation across VA hospital and non-VA hospital acute care. Specific Aim 2: To evaluate the impact of a rapid diagnostic test for c-reactive protein on antibiotic use for adults with acute cough illness when added to a multidimensional intervention.
Methods:
We propose to conduct a randomized controlled trial of a quality improvement program consisting of physician education (educational seminar, practice guidelines, performance feedback, and decision support tools) and patient education (waiting room print and audiovisual materials) in 8 VA hospital and 8 non-VA hospital emergency departments. Non VA study sites will be identified from an existing research network of hospital emergency departments--EDNet. VA hospital sites will be selected among academically affiliated hub facilities. Phase one will involve a hospital-level randomized trial of a multidimensional intervention to translate existing evidence based guidelines for antibiotic use in ARIs vs. usual care. Simultaneously, we will validate a new CRP-based diagnostic algorithm and incorporate it into the evidence based guidelines for antibiotic use in ARIs. Phase two will involve a second hospital-level randomized trial of the new antibiotic use guidelines that incorporate the CRP-based diagnostic algorithm vs. the original guidelines. Specific endpoints include the overall success of the intervention in each phase in terms of reducing antibiotic prescribing for ARIs, improving patient outcomes and reducing resource utilization. In addition we will examin the impact of VA and non-VA organizational factors on the successful translation of various components of the intervention in both phases. Data will be collected using existing administrative data as well as on-site enrollment of subjects in prospective follow-up studies.
Conditions
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Study Design
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RANDOMIZED
FACTORIAL
NONE
Study Groups
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Arm 1
Physician & patient education on appropriate antibiotic use
Rapid C-reactive protein testing to guide antibiotic treatment
Interventions
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Physician & patient education on appropriate antibiotic use
Rapid C-reactive protein testing to guide antibiotic treatment
Eligibility Criteria
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Inclusion Criteria
* Selected VA or Non-VA patients
* Age 18 years or older
* Patient must have acute respiratory illness
* Patient must not have been seen in Emergency Department within 4 weeks
Exclusion Criteria
* Patient in Emergency Department for non-acute respiratory infection
18 Years
ALL
No
Sponsors
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Agency for Healthcare Research and Quality (AHRQ)
FED
US Department of Veterans Affairs
FED
Responsible Party
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Principal Investigators
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Joshua P. Metlay, MD PhD
Role: PRINCIPAL_INVESTIGATOR
Philadelphia VA Medical Center, Philadelphia, PA
Locations
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VA San Diego Healthcare System, San Diego, CA
San Diego, California, United States
Charlie Norwood VA Medical Center, Augusta, GA
Augusta, Georgia, United States
Edward Hines Jr. VA Hospital, Hines, IL
Hines, Illinois, United States
Kansas City VA Medical Center, Kansas City, MO
Kansas City, Missouri, United States
New Mexico VA Health Care System, Albuquerque, NM
Albuquerque, New Mexico, United States
James J. Peters VA Medical Center, Bronx, NY
The Bronx, New York, United States
Philadelphia VA Medical Center, Philadelphia, PA
Philadelphia, Pennsylvania, United States
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, Pennsylvania, United States
South Texas Health Care System, San Antonio, TX
San Antonio, Texas, United States
Countries
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References
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Metlay JP, Camargo CA Jr, Bos K, Gonzales R. Assessing the suitability of intervention sites for quality improvement studies in emergency departments. Acad Emerg Med. 2005 Jul;12(7):667-70. doi: 10.1197/j.aem.2005.01.012.
Gonzales R, Camargo CA Jr, MacKenzie T, Kersey AS, Maselli J, Levin SK, McCulloch CE, Metlay JP; IMPAACT Trial Investigators. Antibiotic treatment of acute respiratory infections in acute care settings. Acad Emerg Med. 2006 Mar;13(3):288-94. doi: 10.1197/j.aem.2005.10.016.
Vanderweil SG, Pelletier AJ, Hamedani AG, Gonzales R, Metlay JP, Camargo CA Jr. Declining antibiotic prescriptions for upper respiratory infections, 1993-2004. Acad Emerg Med. 2007 Apr;14(4):366-9. doi: 10.1197/j.aem.2006.10.096. Epub 2007 Feb 12.
Aspinall SL, Metlay JP, Maselli JH, Gonzales R. Impact of hospital formularies on fluoroquinolone prescribing in emergency departments. Am J Manag Care. 2007 May;13(5):241-8.
Metlay JP, Camargo CA Jr, MacKenzie T, McCulloch C, Maselli J, Levin SK, Kersey A, Gonzales R; IMPAACT Investigators. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann Emerg Med. 2007 Sep;50(3):221-30. doi: 10.1016/j.annemergmed.2007.03.022. Epub 2007 May 23.
Nolt BR, Gonzales R, Maselli J, Aagaard E, Camargo CA Jr, Metlay JP. Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness. Am J Emerg Med. 2007 Jul;25(6):631-6. doi: 10.1016/j.ajem.2006.11.031.
Pines JM, Hollander JE, Lee H, Everett WW, Uscher-Pines L, Metlay JP. Emergency department operational changes in response to pay-for-performance and antibiotic timing in pneumonia. Acad Emerg Med. 2007 Jun;14(6):545-8. doi: 10.1197/j.aem.2007.01.022. Epub 2007 Apr 30.
Other Identifiers
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R01 HF13915
Identifier Type: -
Identifier Source: secondary_id
AVA 03-239
Identifier Type: -
Identifier Source: org_study_id
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