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Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections

Award Number: R01HS028814
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY Inappropriate antibiotic use for the management of acute respiratory tract infections (ARTIs) in ambulatory care is a major driver of antibiotic resistance and an urgent public health threat. Despite decades of research and interventions to increase evidence-based care for ARTIs, limited progress has been made. Telehealth visits (THVs) have the potential to improve ARTI management and antibiotic prescribing by addressing factors that influence inappropriate care and by implementing an approach that optimizes outcomes across populations. The shift to care via THVs necessitated during the peak of the COVID-19 pandemic has created a climate of increased acceptability for telemedicine and an important opportunity to address this question. We propose to leverage the current innovative landscape of expanded use of telehealth to test whether THV approaches for ARTIs can address drivers of inappropriate care and improve management. We seek to conduct a rigorous implementation study using a mixed methods approach to develop and evaluate a multisite intervention designed to improve ARTI care. We will conduct the study in ambulatory healthcare settings from three diverse healthcare systems with patients of a wide range of racial and ethnic backgrounds, those for whom English is not their primary language, and those with disparities related to social determinants of health. Our study will first construct a prediction tool using retrospective data for ARTI encounters (acute sinusitis, pharyngitis, bronchitis, and viral upper respiratory tract infections) at the three sites. The prediction tool will be used to identify candidates for ARTI management via THV who are at low risk for poor outcomes. We will incorporate the tool into the workflow of ambulatory care to optimize appropriate triage to THVs. Second, we will use prior research by our team and other published data to define factors identified as barriers and facilitators for inappropriate prescribing for ARTIs. Using that background, materials will be developed to facilitate appropriate management and to educate patients. Those materials will be created via co-production with providers and community members. Patient materials will be translated in languages reflective of the patient populations served and be culturally sensitive. We will next conduct open pilot testing at hospital-based clinics at each of the three participating healthcare systems to refine the process and materials and get feedback from both patients and providers for adaptation and improvement. Finally, we will implement the approach across six sites – the sites where the three open pilots were conducted and three affiliated community practices. We will study outcomes including antibiotic prescribing, need for follow-up visits and encounters, and patient and provider satisfaction with the THV, the process, and the medical care. Based on our assessment of outcomes, including feasibility and sustainability, final materials will be organized into a toolkit for other sites to implement.


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 = $487,417 )
2024	2024	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	5/9/2024	NON-COMPETING CONTINUATION	$487,417
														Subtotal = $487,417

Issue Date FY: 2023 ( Subtotal = $495,441 )
2023	2023	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	5/11/2023	NON-COMPETING CONTINUATION	$495,441
2023	2022	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	5/11/2023	NEW	$0
														Subtotal = $495,441

Issue Date FY: 2022 ( Subtotal = $500,000 )
2022	2022	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	5/19/2022	NEW	$500,000
														Subtotal = $500,000

Grand Total All Awards = $1,482,858

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Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections

Award Number: R01HS028814

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

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

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