Journal of General Internal Medicine

, Volume 28, Issue 6, pp 810–816

Use of an Electronic Health Record Clinical Decision Support Tool to Improve Antibiotic Prescribing for Acute Respiratory Infections: The ABX-TRIP Study

  • Cara B. Litvin
  • Steven M. Ornstein
  • Andrea M. Wessell
  • Lynne S. Nemeth
  • Paul J. Nietert
Original Research



Antibiotics are often inappropriately prescribed for acute respiratory infections (ARIs).


To assess the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs.


A two-phase, 27-month demonstration project.


Nine primary care practices in PPRNet, a practice-based research network whose members use a common electronic health record (EHR).


Thirty-nine providers were included in the project.


A CDSS was designed as an EHR progress note template. To facilitate CDSS implementation, each practice participated in two to three site visits, sent representatives to two project meetings, and received quarterly performance reports on antibiotic prescribing for ARIs.


1) Use of antibiotics for inappropriate indications. 2) Use of broad spectrum antibiotics when inappropriate. 3) Use of antibiotics for sinusitis and bronchitis.


The CDSS was used 38,592 times during the 27-month intervention; its use was sustained for the study duration. Use of antibiotics for encounters at which diagnoses for which antibiotics are rarely appropriate did not significantly change through the course of the study (estimated 27-month change, 1.57 % [95 % CI, −5.35 %, 8.49 %] in adults and −1.89 % [95 % CI, −9.03 %, 5.26 %] in children). However, use of broad spectrum antibiotics for ARI encounters improved significantly (estimated 27 month change, −16.30 %, [95 % CI, −24.81 %, −7.79 %] in adults and −16.30 [95%CI, −23.29 %, −9.31 %] in children). Prescribing for bronchitis did not change significantly, but use of broad spectrum antibiotics for sinusitis declined.


This multi-method intervention appears to have had a sustained impact on reducing the use of broad spectrum antibiotics for ARIs. This intervention shows promise for promoting judicious antibiotic use in primary care.


acute respiratory infections antibiotic prescribing electronic health records clinical decision support 


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Cara B. Litvin
    • 1
  • Steven M. Ornstein
    • 2
  • Andrea M. Wessell
    • 2
  • Lynne S. Nemeth
    • 3
  • Paul J. Nietert
    • 4
  1. 1.Division of General Internal Medicine and Geriatrics, Department of MedicineMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Family MedicineMedical University of South CarolinaCharlestonUSA
  3. 3.College of NursingMedical University of South CarolinaCharlestonUSA
  4. 4.Division of Biostatistics and Epidemiology, Department of MedicineMedical University of South CarolinaCharlestonUSA

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