Improving Care for Acute Respiratory Infection

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DESCRIPTION (provided by the applicant): The candidate, an academic general internist, is applying for a Mentored Clinical Scientist Development Award (K08) to develop and enhance the skills necessary to become a successful independent health services researcher. His long-term goal is to develop a multidisciplinary research program dedicated to improving the care of patients with acute respiratory infections (ARIs) while improving links between the private and public health systems to provide surveillance for naturally occurring disease clusters and bioterrorism. Central to his career development is the strong institutional commitments and mentoring team that he has assembled. The multidisciplinary educational plan is built upon acquiring new skills in informatics, advanced biostatistics, patient safety, research ethics, public health, and disease surveillance. In addition to formal coursework, the plan includes local seminars, national scientific meetings, and peer-reviewed publication of results. Each of the four specific aims of the research plan involves the development and implementation of an electronic medical record-based template for ARI visits, the ARI Smart Set. Specific Aim 1 is to develop the ARI Smart Set, which will standardize documentation of care and give providers easy access to clinical information, on-line decision support, and patient education materials. Specific Aim 2 is to perform a randomized controlled trial of the ARI Smart Set to assess its effectiveness in decreasing antibiotic prescribing in primary care practices. Specific Aim 3a is to connect the ARI Smart Set with a national disease surveillance program, the National Bioterrorism Syndromic Surveillance Demonstration Project, to provide an automated, bi-directional link between the personal and public health systems. Specific Aim 3b is to perform a randomized controlled trial of providing clinicians with point-of-care, real-time data about the prevalence of influenza and other respiratory illnesses in an individual patient's neighborhood through the ARI Smart Set. The primary outcome is 30-day antibiotic prescribing for patients with influenza-like illnesses. The research plan will provide critical information about the care of patients with ARIs and the interface between the personal and public health systems. The research plan will also provide crucial experience for the candidate in medical informatics, disease surveillance, randomized controlled trial design and implementation, data collection, data analysis, database management, statistical analysis, and intervention research.