title: Use of an institutional intervention to improve quality of care for adolescents treated in pediatric ambulatory settings for pelvic inflammatory disease.
abstract: OBJECTIVE
  To evaluate the impact of a quality improvement intervention for outpatient management of pelvic inflammatory disease (PID) on provider compliance with published guidelines and to explore issues affecting patient adherence to outpatient care regimens.
  
  
  METHODS
  This study utilized an interrupted time series design. The intervention included an algorithm and clinical practice guideline based on the 2002 Centers for Disease Control STD Guidelines, a complete course of medications to be given at discharge after initial doses given in the site, standardized discharge instructions, close follow-up at 24-48 hours and after two weeks of treatment by a member of the PID team, and a referral for follow-up.
  
  
  RESULTS
  At baseline, 38% of patients did not receive an appropriate medication regimen and only 10% of clinic outpatients returned for follow-up evaluations within 72 hours. In the postintervention group, 91% of patients received an appropriate outpatient regimen and 43% of emergency department and clinic patients returned for care. Based on the results of logistic regression models, adolescents in the postintervention group were 8.4 times more likely (adjusted odds ratio [AOR]: 8.4, confidence interval [CI]: 2.6-26.8, p <. 001) to receive an appropriate outpatient medication regimen than girls in the baseline group. Follow-up interview revealed that 61% of postintervention patients completed all doses of the medication, 67% practiced temporary abstinence, 86% notified their partner for treatment, and 96% were satisfied with their care.
  
  
  CONCLUSIONS
  Interventions utilizing a multi-level approach to the management of outpatient PID improve provider compliance with published guidelines and quality of care delivered to adolescents in academic settings. Many adolescents, however, continue to have difficulty with adherence. Additional research is warranted to address adherence to outpatient regimens for the treatment of PID in adolescent girls.
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA. mtrent2@jhmi.edu
authors.forename: Maria
authors.initials: M
authors.lastname: Trent
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Judy
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
authors.forename: Allen
authors.initials: A
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D000553:Ambulatory Care / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D010349:Patient Compliance; D017060:Patient Satisfaction; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care