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Decreasing antibiotic prescribing in acute respiratory infections through implementation of nurse driven clinical decision support

Award Number: R01AI108680
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Project summary Overuse of antibiotics for acute respiratory infections (ARIs) continues to drive increasing antibiotic resistance. Provider-driven clinical decision support (CDS) has had a minimal impact on decreasing antibiotic prescribing rates. The overall objectives of this application are to 1) implement registered nurse (RN)-driven CDS containing integrated clinical prediction rules (iCPRs) [decision aids embedded into the electronic health record which determine risk of bacterial infection based on elements of the patient history and physical examination] and 2) determine the impact of RN-driven CDS on inappropriate antibiotic prescribing and resource use. The central hypothesis is that RNs using iCPR will accurately determine patients’ risk for bacterial ARI, recommend appropriate testing and treatment based on that risk and will have lower rates of inappropriate antibiotic prescribing compared to providers. The rationale for this project is that a CDS tool can allow RNs to work at the full scope of their licenses and decrease inappropriate antibiotic prescribing. This central hypothesis will be tested using three specific aims: 1) adapt and implement an RN driven iCPR tool for evaluation and treatment of patients with ARIs in primary care and urgent care practices; 2) determine the impact of the RN driven iCPR on antibiotic prescribing, diagnostic test-ordering, resource use patterns, and cost-effectiveness; and 3) use a theory-driven implementation framework to identify barriers and facilitators to, and optimize factors influencing, effective implementation of an RN-driven iCPR. For the first aim, the previously developed and studied provider iCPR will be adapted for RN workflow and a RN training program will be implemented to train RNs in its use for patient evaluation and treatment. For the second aim, a stepped wedge cluster randomized trial will be conducted at primary care and urgent care clinics at the four participating institutions. For the third aim, the Technology Acceptance Model (TAM3) and Proctor’s Framework will be used as guides to assess implementation outcomes and use findings to drive post-implementation tool optimization and create an implementation toolkit. The proposed project is innovative because it: 1) uses CDS tools with risk stratification to enable RNs to lead initial ARI assessment and treatment; 2) uses an evidence-based implementation framework to evaluate outcomes and identify barriers and facilitators; and 3) evaluates the cost of the intervention which is critical in increasing dissemination potential. The proposed research is significant because it is expected to provide a scalable implementation model leveraging CDS and RN training tools to decrease antibiotic overuse, lower the cost of care, and ultimately reduce antibiotic resistance.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $711,334 )
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	000	11	11/9/2023	NON-COMPETING CONTINUATION	$640,200
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	001	11	5/16/2024	NON-COMPETING CONTINUATION	$71,134
														Subtotal = $711,334

Issue Date FY: 2023 ( Subtotal = $740,846 )
2023	2023	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	000	10	11/17/2022	NON-COMPETING CONTINUATION	$740,846
														Subtotal = $740,846

Issue Date FY: 2022 ( Subtotal = $752,822 )
2022	2022	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	000	9	11/23/2021	NON-COMPETING CONTINUATION	$752,822
														Subtotal = $752,822

Issue Date FY: 2021 ( Subtotal = $775,353 )
2021	2021	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	000	8	2/1/2021	NON-COMPETING CONTINUATION	$775,353
														Subtotal = $775,353

Issue Date FY: 2020 ( Subtotal = $848,109 )
2020	2020	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	001	7	12/23/2019	COMPETING CONTINUATION	$848,109
2020	2020	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	003	7	5/19/2020	COMPETING CONTINUATION	$23,721
2020	2018	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	002	6	5/19/2020	SUPPLEMENT FOR EXPANSION	-$23,721
2020	2018	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	000	6	12/20/2019	NON-COMPETING CONTINUATION	$0
														Subtotal = $848,109

Issue Date FY: 2018 ( Subtotal = $816,357 )
2018	2018	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	001	6	7/20/2018	SUPPLEMENT FOR EXPANSION	$116,325
2018	2018	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	000	6	3/14/2018	NON-COMPETING CONTINUATION	$700,032
														Subtotal = $816,357

Issue Date FY: 2017 ( Subtotal = $839,546 )
2017	2017	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	003	5	3/21/2017	NON-COMPETING CONTINUATION	$770,156
2017	2016	TRUSTEES OF BOSTON UNIVERSITY	85 E NEWTON ST M-921	BOSTON	MA	02118	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	3	12/13/2016	NON-COMPETING CONTINUATION	-$702,436
2017	2016	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	006	4	3/23/2017	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$125,506
2017	2016	TRUSTEES OF BOSTON UNIVERSITY	85 E NEWTON ST M-921	BOSTON	MA	02118	SUFFOLK	USA	Allergy and Infectious Diseases Research	005	3	3/23/2017	NON-COMPETING CONTINUATION	-$24,650
2017	2016	TRUSTEES OF BOSTON UNIVERSITY	85 E NEWTON ST M-921	BOSTON	MA	02118	SUFFOLK	USA	Allergy and Infectious Diseases Research	001	3	12/13/2016	SUPPLEMENT FOR EXPANSION	-$126,126
2017	2016	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Allergy and Infectious Diseases Research	002	4	12/13/2016	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$897,952
2017	2015	TRUSTEES OF BOSTON UNIVERSITY	85 E NEWTON ST M-921	BOSTON	MA	02118	SUFFOLK	USA	Allergy and Infectious Diseases Research	004	2	3/23/2017	NON-COMPETING CONTINUATION	-$100,856
														Subtotal = $839,546

Issue Date FY: 2016 ( Subtotal = $853,212 )
2016	2016	BOSTON UNIVERSITY	25 BUICK ST	BOSTON	MA	02215	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	3	3/23/2016	NON-COMPETING CONTINUATION	$727,086
2016	2016	BOSTON UNIVERSITY	25 BUICK ST	BOSTON	MA	02215	SUFFOLK	USA	Allergy and Infectious Diseases Research	001	3	6/30/2016	SUPPLEMENT FOR EXPANSION	$126,126
														Subtotal = $853,212

Issue Date FY: 2015 ( Subtotal = $848,222 )
2015	2015	BOSTON UNIVERSITY	25 BUICK STREET	BOSTON	MA	02215	SUFFOLK	USA	Allergy and Infectious Diseases Research	002	2	8/24/2015	NON-COMPETING CONTINUATION	$0
2015	2015	BOSTON UNIVERSITY	25 BUICK ST	BOSTON	MA	02215	SUFFOLK	USA	Allergy and Infectious Diseases Research	001	2	8/21/2015	NON-COMPETING CONTINUATION	$113,840
2015	2015	BOSTON UNIVERSITY	25 BUICK ST	BOSTON	MA	02215	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	2	3/31/2015	NON-COMPETING CONTINUATION	$734,382
														Subtotal = $848,222

Issue Date FY: 2014 ( Subtotal = $743,552 )
2014	2014	BOSTON UNIVERSITY	25 BUICK ST	BOSTON	MA	02215	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	1	4/15/2014	NEW	$743,552
														Subtotal = $743,552

Grand Total All Awards = $7,929,353

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Decreasing antibiotic prescribing in acute respiratory infections through implementation of nurse driven clinical decision support

Award Number: R01AI108680

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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