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
