Health system implementation of clinical decision support to optimize respiratory pathogen profile utilization

Area of Science:

• Medical Diagnostics
• Health Informatics
• Clinical Microbiology

Background:

• Overutilization of respiratory pathogen profiles (RPPs) in immunocompetent patients offers limited clinical benefit and increases healthcare costs.
• Evidence suggests RPPs are most beneficial for severely ill, immunosuppressed, or pediatric patients, while smaller, targeted tests suffice for routine cases.
• Diagnostic stewardship is crucial for optimizing the use of multiplex molecular assays, ensuring appropriate test selection, resource utilization, and interpretation.

Purpose of the Study:

• To evaluate the impact of a clinical decision support (CDS) intervention on RPP utilization and associated reagent costs.
• To assess the effectiveness of a CDS tool in guiding appropriate RPP ordering or redirecting to smaller, targeted tests.
• To quantify the cost savings achieved through reduced RPP overutilization.

Main Methods:

• A retrospective analysis of RPP utilization in inpatient and emergency departments from January 2022 to January 2026.
• Implementation of a CDS tool that defaulted to a seasonal respiratory viral profile (SRVP) and prompted users with clinical indications before RPP selection.
• Interrupted time series analysis to assess the impact of CDS implementation on RPP ordering practices.

Main Results:

• A significant decrease in RPP orders post-CDS implementation (-946.70, 95% CI: -1,320.2 to -573.2) compared to the pre-CDS period.
• The CDS intervention resulted in approximately $2.26 million in reagent cost savings.
• The CDS tool successfully reduced the overutilization of large respiratory pathogen syndromic panels.

Conclusions:

• The introduction of a CDS intervention effectively curbed the overuse of RPPs in immunocompetent patients.
• The CDS tool promoted diagnostic stewardship by encouraging the use of SRVPs when clinically appropriate.
• The intervention demonstrated significant cost savings and improved the value of multiplex testing.