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Project Timeline
Visual of the IMPAACT Project design
(some modifications were made to the CRP research plan after preliminary IMPAACT findings)

The IMPAACT Project is a randomized controlled trial of a quality improvement program consisting of physician education (educational seminar, practice guidelines, performance feedback, and decision support tools) and patient education (waiting room print and audiovisual materials) in eight VA hospital urgent care clinics and eight non-VA hospital emergency departments. Non-VA study sites were identified from EMNet, an existing research network of hospital emergency departments. VA urgent care clinic sites were selected among academically affiliated hub facilities.

Project Aim 1: To evaluate the impact of a multidimensional (patient, system, clinician) intervention on appropriate antibiotic use for adults with acute respiratory tract infections; identifying factors that influence successful translation across VA and non-VA hospital acute care settings.

Project Aim 2: To evaluate the impact of a rapid diagnostic test for c-reactive protein on antibiotic use for adults with acute cough illness when added to a multidimensional intervention.

Preliminary studies suggest that a rapid, bedside c-reactive protein test on a fingerstick blood specimen can help classify adults at very low risk, and at high risk, for community-acquired pneumonia. In a second phase of the study, we propose to evaluate the incremental impact of a c-reactive protein-based diagnostic algorithm to improve antibiotic prescribing behavior. Although the rate of antibiotic prescribing for ARIs by office-based physicians in the US has decreased about 16% from its peak in 1997, the rate of antibiotic prescribing in acute care settings (e.g., emergency departments and urgent care centers), which account for 1 in 5 ambulatory antibiotic prescriptions in the US, has shown only a modest decline (6%) during this period. Translation of lessons from intervention studies in office-based practices is needed to improve antibiotic use in acute care settings.