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Appl Clin Inform 2020; 11(02): 315-322
DOI: 10.1055/s-0040-1709507
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Noninterruptive Clinical Decision Support Decreases Ordering of Respiratory Viral Panels during Influenza Season

Cameron Escovedo
1   Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
,
Douglas Bell
2   Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
,
Eric Cheng
3   Department of Neurology, University of California, Los Angeles, Los Angeles, California, United States
,
Omai Garner
4   Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, United States
,
Alyssa Ziman
4   Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, United States
,
Sitaram Vangala
5   Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, California, United States
,
Prabhu Gounder
6   Acute Communicable Disease Control, County of Los Angeles Public Health, Los Angeles, California, United States
,
Carlos Lerner
1   Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
› Author Affiliations Funding None.
Further Information

Publication History

06 December 2019

26 February 2020

Publication Date:
29 April 2020 (online)

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Abstract

Objective A growing body of evidence suggests that testing for influenza virus alone is more appropriate than multiplex respiratory viral panel (RVP) testing for general populations of patients with respiratory tract infections. We aimed to decrease the proportion of RVPs out of total respiratory viral testing ordered during influenza season.

Methods We implemented two consecutive interventions: reflex testing for RVPs only after a negative influenza test, and noninterruptive clinical decision support (CDS) including modifications of the computerized physician order entry search behavior and cost display. We conducted an interrupted time series of RVPs and influenza polymerase chain reaction tests pre- and postintervention, and performed a mixed-effects logistic regression analysis with a primary outcome of proportion of RVPs out of total respiratory viral tests. The primary predictor was the intervention period, and covariates included the provider, clinical setting, associated diagnoses, and influenza incidence.

Results From March 2013 to April 2019, there were 24,294 RVPs and 26,012 influenza tests (n = 50,306). Odds of ordering an RVP decreased during the reflex testing period (odds ratio: 0.432, 95% confidence interval: 0.397–0.469), and decreased more dramatically during the noninterruptive CDS period (odds ratio: 0.291, 95% confidence interval: 0.259–0.327).

Discussion The odds of ordering an RVP were 71% less with the noninterruptive CDS intervention, which projected 4,773 fewer RVPs compared with baseline. Assuming a cost equal to Medicare reimbursement rates for RVPs and influenza tests, this would generate an estimated averted cost of $1,259,474 per year.

Conclusion Noninterruptive CDS interventions are effective in reducing unnecessary and expensive testing, and avoid typical pitfalls such as alert fatigue.

Keywords

influenza - human - respiratory tract infections - multiplex polymerase chain reaction - decision support systems - clinical - cost control - computer-assisted decision-making - alert fatigue

Protection of Human and Animal Subjects

The UCLA Institional Review Board has approved this study and determined that the research meets the requirements for expedited review.


 

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