How Does the Clinical Tool 'What's Going Around' Affect Clinical Practice
How Does the Clinical Tool 'What's Going Around' Affect Clinical Practice
Previous work has shown that the epidemiological context of a patient's presentation can
 provide important information for clinicians to aid in diagnosis and treatment. With current
 electronic health records, it is increasingly possible to perform syndromic surveillance that
 is local and specific to a patient's characteristics.

 The investigators have developed algorithms for syndromic surveillance for a number of
 conditions in which contextual information might be of use to treating clinicians. The
 syndromic surveillance algorithms already developed are for influenza-like-illness, whooping
 cough, asthma exacerbation, Group A Streptococcal pharyngitis, and gastroenteritis infection.

 The investigators plan on studying these tools with a clustered randomized control cohort
 study evaluating how clinical decision making is affected by use of these tools by outpatient
 general practitioners. The goal is to incorporate these validated algorithms into a quality
 improvement tool which will provide point-of-care clinical decision support to clinicians
The epidemiological context of a patient's presentation can provide important information for
 clinicians to aid in diagnosis and treatment. The investigators previously developed and
 validated a syndromic surveillance tool for detecting influenza-like illness (ILI)
 encounters. The investigators then evaluated 40,642 outpatient ILI episodes during 'flu
 seasons' over 6 years. The investigators found that even after controlling for patient
 presentation and physician factors, the context in which a patient presented was strongly
 associated with the likelihood that an antimicrobial agent would be prescribed. Specifically,
 patients were less likely to be prescribed an antibiotic if they presented with ILI during
 the pandemic influenza period (when awareness of 'flu season' was very high), or after their
 physician had personally seen many patients with ILI in the prior week.

 Currently, most clinicians have only limited access to data regarding the 'context' in which
 a patient presents. Under such circumstances, physicians are often unaware of local
 epidemiological information that could help them make optimal treatment decisions. In centers
 with advanced use of electronic health records (EHRs), it is increasingly possible to perform
 syndromic surveillance that is local (e.g. specific to a neighborhood or school district),
 current (e.g. updated daily), and specific to a patient's characteristics (e.g. age, chief
 complaint).

 To that end, the investigators have developed algorithms for syndromic surveillance for a
 number of syndromes including Asthma, ILI, Pertussis, Group A Streptococcus Pharyngitis, and
 Gastroenteritis. These algorithms may provide contextual information that might be of use to
 clinicians.

 The purpose of this study is to determine the effect of how a point-of-care clinical decision
 tool in the form of syndromic surveillance algorithms affect clinical decision making amongst
 outpatient health care providers and also patient outcomes. We will be using a 2 year look
 back prior to tool roll out as a comparison.

 Specific Aims:

 To determine the effect this point-of-care clinical decision tool has on clinical decision
 making amongst primary care providers.

 To determine the clinical outcomes of patients whose physicians had access to these tools

 To understand how these point-of-care clinical decision tools are used among healthcare
 providers in day to day practice
Inclusion Criteria:

 All patients seen in a Northshore University HealthSystem outpatient clinic (Family
 Medicine, Internal Medicine or Pediatric) between the Nov 1 2013 to Oct 31 2014

 Exclusion Criteria:

 None