The volume-quality relationship in antibiotic prescribing: when more isn't better.
The volume-quality relationship in antibiotic prescribing: when more isn't better.
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DOI：
10.1177/0046958015571130
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Mehrotra A
中科院分区：
文献类型：
--
作者：
Gidengil CA;Linder JA;Hunter G;Setodji C;Mehrotra A
对于许多手术和高风险的医疗条件，更多的供应商提供更高质量的护理。体积对诸如急性呼吸道感染（ARIs）等更常见的医疗状况的影响尚未得到研究。使用成人急性呼吸道感染门诊的电子健康记录数据，我们将初级保健医生分为急性呼吸道感染数量五分之一。我们拟合了抗生素处方率的线性回归模型，以评估趋势上的显著差异。ARI容积越大的医生在许多领域的质量就越低，包括更高的抗生素处方率、更高的广谱抗生素处方和更低的指南一致性。有较多病例的医生处理急性呼吸道感染的方式非常不同，并且更有可能开抗生素。当他们为可能需要使用抗生素的诊断开出抗生素时，他们不太可能开出符合指南的抗生素。鉴于大量医生占ARI就诊的大部分，针对这一群体的努力可能会在提高质量方面产生重要的人口效应。
For many surgeries and high-risk medical conditions, higher volume providers provide higher quality care. The impact of volume on more common medical conditions such as acute respiratory infections (ARIs) has not been examined. Using electronic health record data for adult ambulatory ARI visits, we divided primary care physicians into ARI volume quintiles. We fitted a linear regression model of antibiotic prescribing rates across quintiles to assess for a significant difference in trend. Higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. Physicians with a higher volume of cases manage ARI very differently and are more likely to prescribe antibiotics. When they prescribe an antibiotic for a diagnosis for which an antibiotic may be indicated, they are less likely to prescribe guideline-concordant antibiotics. Given that high-volume physicians account for the bulk of ARI visits, efforts targeting this group are likely to yield important population effects in improving quality.
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