• Jeffrey A Linder, Jeffrey L Schnipper, Ruslana Tsurikova, D Tony Yu, Lynn A Volk, Andrea J Melnikas, Matvey B Palchuk, Maya Olsha-Yehiav, and Blackford Middleton.
• Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA. jlinder@partners.org
• Am J Manag Care. 2010 Dec 1;16(12 Suppl HIT):e311-9.

ObjectiveTo examine whether the Acute Respiratory Infection (ARI) Quality Dashboard, an electronic health record (EHR)-based feedback system, changed antibiotic prescribing.Study DesignCluster randomized, controlled trial.MethodsWe randomly assigned 27 primary care practices to receive the ARI Quality Dashboard or usual care. The primary outcome was the intent-to-intervene antibiotic prescribing rate for ARI visits. We also compared antibiotic prescribing between ARI Quality Dashboard users and nonusers.ResultsDuring the 9-month intervention, there was no difference between intervention and control practices in antibiotic prescribing for all ARI visits (47% vs 47%; P = .87), antibiotic-appropriate ARI visits (65% vs 64%; P = .68), or non–antibiotic-appropriate ARI visits (38% vs 40%; P = .70). Among the 258 intervention clinicians, 72 (28%) used the ARI Quality Dashboard at least once. These clinicians had a lower overall ARI antibiotic prescribing rate (42% vs 50% for nonusers; P = .02). This difference was due to less antibiotic prescribing for non-antibiotic-appropriate ARIs (32% vs 43%; P = .004), including nonstreptococcal pharyngitis (31% vs 41%; P = .01) and nonspecific upper respiratory infections (19% vs 34%; P = .01).ConclusionsThe ARI Quality Dashboard was not associated with an overall change in antibiotic prescribing for ARIs, although when used, it was associated with improved antibiotic prescribing. EHR-based quality reporting, as part of "meaningful use," may not improve care in the absence of other changes to primary care practice.

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