Using Implementation Science and Informatics to Develop and Pilot Test Antibiotic Stewardship Clinical Decision Support

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Project Summary/Abstract Dentists are responsible for approximately 10% of outpatient antibiotic prescriptions in the United States. Many of these antibiotic prescriptions are unnecessary and place patients at risk of adverse drug events, including allergic reactions and infections with drug resistant organisms. However, improving antibiotic prescribing practices in dental settings is challenging. Dental clinics often lack the resources to design and implement policies to evaluate dental antibiotic prescribing practices and design interventions to improve prescribing practices. My long-term goal is to oversee the development of electronic clinical decision support tools (CDST) to facilitate optimal antibiotic prescribing among dentists. I envision creating, pilot testing, and disseminating CDSTs that can be embedded within electronic health record systems, including electronic dental record systems, to improve adherence to science-based practices while making the lives of clinicians easier. This specific proposal aims to design and implement a novel web-based application “app” that can be accessed by dentists on mobile phones or websites. Our first aim is to design the CDST based on focus group feedback from dental students, residents, and faculty at the University of Illinois College of Dentistry (UIC- COD). Our second aim is to pilot test the app using clinical vignettes and validated technology survey questions. The third aim is to evaluate the effectiveness and implementation of our CDST within UIC-COD using a dissemination and implementation research framework. We will propose to measure changes in antibiotic knowledge and confidence in antibiotic decision making before and after implementation of the CDST using paired surveys. We will also use surveys to measure provider satisfaction with the CDST. We will track CDST usage (implementation metrics) using Google analytics. After completion of this project, we plan to test our CDST in community dentists via the National Institute for Dental and Craniofacial Research Dental Practice Based Research Network and apply for grant funding to embed this CDST into electronic dental record systems.