Optimizing Implementation of Multiplex Molecular Panel Testing to Reduce Diagnostic Error

Respiratory and gastrointestinal complaints are among the most common reasons why adults
are prescribed antibiotics in acute care. In recent years, multiplex molecular panels that rapidly
test for 15-25 for pathogens simultaneously, including bacteria and viruses, have entered
common use and dramatically changed clinicians’ basic approach to these conditions. The
potential advantage of multiplex panels is that, if uses properly, rapid diagnosis may facilitate
targeted antibiotic or antiviral therapy. But multiplex panels are “shotgun” tests that frequently
produce false positives. When implemented without consideration of unintended consequences,
their use can either have no impact or lead to inappropriate antibiotics. This study will address a
gap in the literature by identifying when multiplex panel tests can change clinical management
or benefit the patient and designing interventions to nudge testing in those situations.
The proposed studies will promote patient safety and reduce misdiagnosis through diagnostic
stewardship, an emerging model for infectious diseases care that uses “nudge” interventions to
encourage evidence-based testing. Aim 1 will define high- and low-value use of multiplex panel
testing by examining clinical outcomes after testing among patients seen in acute care at 200
hospitals contributing to the Premier Healthcare Database. Aim 2 will develop electronic health
record-based interventions to nudge better testing practices in acute care based on qualitative
input from frontline clinicians. Aim 3 will be a quasi-experimental trial of diagnostic stewardship
interventions at two hospitals in the University of Maryland System. Other system hospitals will
be concurrent controls. This research will lead to the first large-scale trial evaluating diagnostic
stewardship of multiplex molecular panel tests in acute care.
I am an infectious disease physician and hospital epidemiologist with a PhD in health services
research. My long-term career goal is to become an independent investigator performing health
services research to redesign systems of care with a focus on molecular diagnostics for patients
with suspected infections. To achieve this goal, I will undergo formal training in molecular
microbiology, healthcare informatics, and implementation science. I will be mentored by an
interdisciplinary team including Dr. Daniel Morgan, an AHRQ-funded expert in diagnostic
stewardship, Dr. J. Kristie Johnson, expert in clinical microbiology, Dr. Sarah Krein, an expert in
mixed methods and user-centered design, and Dr. Anthony Harris, an expert in quasi-
experimental trials. The long-term scientific goal of my research is to improve antibiotic use
through high-quality and high-value diagnostic testing for infectious diseases.

Grant Number: 5K08HS028854-04
NIH Institute/Center: AHRQ
Principal Investigator: Jonathan Baghdadi