Grant Number: R03 HS13195
RFA/PA: PAR01-040 - Small Research Grant Program (replace 96-028/ addendum)
PI Name: CHRISTAKIS, DIMITRI
Project Title: A Diagnostic Decision Aid for Pediatric Sinusitis

Abstract:

Upper respiratory infections (URls) are a leading cause of acute visits to pediatric providers, and the majority of children presenting with URIs are likely to receive antibiotics either with or without a concurrent bacterial diagnosis. One large study has found that almost 50% of children with URIs are inappropriately treated with antibiotics. This likely underestimates the true degree of unnecessary antibiotic use since physicians may ascribe non-specific symptoms to bacterial etiologies (eg. by diagnosing sinusitis in the setting of cold symptoms) so as to justify their use of antibiotics. Although fewer than 20% of children who visit physicians for URIs meet criteria for bacterial sinusitis, as many as 50-70% may be diagnosed with sinusitis and given antibiotics. Such overuse of antibiotics increases antibiotic resistance, increases medical costs, and increases risk for antibiotic-associated adverse events.

Unfortunately, changing physician behavior has proven to be difficult and costly. Clinical practice guidelines have not been well received by providers. Continuing medical education is largely ineffective. Academic detailing is marginally effective but is labor-intensive. Importantly, it is not that physicians do not welcome guidance in clinical decision making but rather that many current and past efforts have failed to meet their expectations. Providers are in search of and in need of pertinent and helpful evidence based solutions that do not increase their workload. This proposal involves testing the ability of diagnostic decision aid to improve the diagnostic accuracy of sinusitis.

We will explore whether use of a diagnostic decision aid which is completed by parents in the waiting room prior to being seen can assist providers in more accurately diagnosing sinusitis and thereby diminish inappropriate antibiotic use. We propose to conduct a randomized controlled trial using wireless hand-held computers in a university-based clinic. This setting will answer important complementary questions. First, can a DDA prove useful to providers? Second, can it be integrated into a wireless computerized clinical information system?


Fiscal Year: 2002
Department: UNIVERSITY OF WASHINGTON
Project Start: 09/30/2002
Project End: 09/29/2004
IRG: ZHS1