• Arch G Mainous, Carol A Lambourne, and Paul J Nietert.
• Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. mainouag@musc.edu
• J Am Med Inform Assoc. 2013 Mar 1;20(2):317-24.

ObjectiveTo assess the effect of a clinical decision support system (CDSS) integrated into an electronic health record (EHR) on antibiotic prescribing for acute respiratory infections (ARIs) in primary care.Materials And MethodsQuasi-experimental design with nine intervention practices and 61 control practices in the Practice Partner Research Network, a network of practices which all use the same EHR (Practice Partner). The nine intervention practices were located in nine US states. The design included a 3-month baseline data collection period (October through December 2009) before the introduction of the intervention and 15 months of follow-up (January 2010 through March 2011). The main outcome measures were the prescribing of antibiotics in ARI episodes for which antibiotics are inappropriate and prescribing of broad-spectrum antibiotics in all ARI episodes.ResultsIn adult patients, prescribing of antibiotics in ARI episodes where antibiotics are inappropriate declined more (-0.6%) among intervention practices than in control practices (+4.2%) (p=0.03). However, among adults, the CDSS intervention improved prescribing of broad-spectrum antibiotics, with a decline of 16.6% among intervention practices versus an increase of 1.1% in control practices (p<0.0001). A similar effect on broad-spectrum antibiotic prescribing was found in pediatric patients with a decline of 19.7% among intervention practices versus an increase of 0.9% in control practices (p<0.0001).ConclusionsA CDSS embedded in an EHR had a modest effect in changing prescribing for adults where antibiotics were inappropriate but had a substantial impact on changing the overall prescribing of broad-spectrum antibiotics among pediatric and adult patients.

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