Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.
Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.
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DOI：
10.1177/0046958016636531
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Mehrotra A
中科院分区：
文献类型：
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作者：
Gidengil CA;Linder JA;Beach S;Setodji CM;Hunter G;Mehrotra A
急性呼吸道感染（阿里斯）抗生素处方过量是常见的。我们的目标是开发和验证一种基于晕影的方法来估计临床医生ARI抗生素处方。我们在2013年1月至9月期间调查了医生（n = 78）和零售诊所临床医生（n = 109）。我们使用一组ARI小插曲调查临床医生，并将这些临床医生在2012年期间管理的所有ARI访问的响应与电子健康记录数据相关联。然后，我们创建了一个新的抗生素处方衡量标准，即综合ARI管理率。这被定义为不为不适当的诊断开具抗生素处方，为适当的诊断开具指南一致的抗生素处方（还包括适当使用链球菌检测咽炎小插曲）。我们在临床医生层面比较了基于插图和基于图表的全面ARI管理。然后，我们确定了最好的预测综合ARI管理率的小插曲的组合，使用分区算法。对3个小插曲的反应将临床医生分为4组，基于图表的综合ARI管理率分别为61%（n = 121）、50%（n = 47）、31%（n = 12）和22%（n = 7）。对3个临床小插曲的反应可以识别出质量相对较差的ARI抗生素处方的临床医生。小插曲可能是一种机制，以针对临床医生的质量改进工作。
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. Our objective was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. We surveyed physicians (n = 78) and retail clinic clinicians (n = 109) between January and September 2013. We surveyed clinicians using a set of ARI vignettes and linked the responses to electronic health record data for all ARI visits managed by these clinicians during 2012. We then created a new measure of antibiotic prescribing, the comprehensive ARI management rate. This was defined as not prescribing antibiotics for antibiotic-inappropriate diagnoses and prescribing guideline-concordant antibiotics for antibiotic-appropriate diagnoses (and also included appropriate use of streptococcal testing for the pharyngitis vignettes). We compared the vignette-based and chart-based comprehensive ARI management at the clinician level. We then identified the combination of vignettes that best predicted comprehensive ARI management rates, using a partitioning algorithm. Responses to 3 vignettes partitioned clinicians into 4 groups with chart-based comprehensive ARI management rates of 61% (n = 121), 50% (n = 47), 31% (n = 12), and 22% (n = 7). Responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.