title: Evaluating Quality of Care for Sexually Transmitted Infections in Different Clinical Settings.
abstract: BACKGROUND
  We examined quality of care across different clinical settings within a large safety-net hospital in Massachusetts for patients presenting with penile discharge/dysuria or vaginal discharge.
  
  
  METHODS
  Using a modified Delphi approach, a list of sex-specific sexually transmitted infection (STI) quality measures, covering 7 domains of clinical care (history, examination, laboratory testing, assessment, treatment, additional screening, counseling), was selected as standard of care by a panel of 5 STI experts representing emergency department (ED), obstetrics/gynecology (Ob/Gyn), family medicine (FM), primary care (PC), and infectious disease. Final measures were piloted with 50 charts per sex from the STI Clinic and age, sex, and visit date-matched charts from PC, FM, ED, and Ob/Gyn. Performance was scored as compliance among individual measures within 7 domains, standardized to add up to one to adjust for variable number of measures per domain, with an overall score of 7 indicating complete adherence to standards.
  
  
  RESULTS
  Expert review process took 2 weeks and resulted in 24 and 34 final measures for male and female patients, respectively. Performance on 7 clinical domains ranged from 3.16 to 4.36 for male patients and 3.17 to 4.33 for female patients. Sexually transmitted infection clinic seemed to score higher on laboratory testing, additional screening, and counseling, but lower on examination and assessment, and ED seemed to score higher on examination and treatment, PC and FM on laboratory testing for male patients and on examination and treatment for female patients, and Ob/Gyn on treatment.
  
  
  CONCLUSIONS
  An instrument to discern standard of care and identify strengths and weaknesses in specific domains of clinical documentation for patients presenting with STI complaints can be developed and implemented for quality evaluation across care settings. Further research is needed on whether these findings can be integrated into site-specific quality improvement processes and linked to cost analyses.
authors.affiliation: From the *Boston University School of Medicine, Boston, MA; †Massachusetts Department of Public Health, Boston, MA; and ‡Boston University School of Public Health, Boston, MA.
authors.forename: Shwetha
authors.initials: S
authors.lastname: Sequeira
authors.forename: Jake R
authors.initials: JR
authors.lastname: Morgan
authors.forename: Maura
authors.initials: M
authors.lastname: Fagan
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Hsu
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
mesh_terms: D000328:Adult; D003697:Delphi Technique; D037001:Directive Counseling; D053159:Dysuria / Q000209:etiology / Q000821:virology*; D004636:Emergency Service, Hospital / Q000592:standards*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008487:Medical History Taking; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards*; D010413:Penis / Q000382:microbiology / Q000821:virology; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000628:therapy*; D019522:Vaginal Discharge / Q000382:microbiology / Q000821:virology