Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.
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.
RAND Corporation, Boston, MA, USA Boston Children's Hospital, Boston, MA Harvard Medical School, Boston, MA, USA gidengil@rand.org.
Courtney A
CA
Gidengil
Brigham and Women's Hospital, Boston, MA University of Pittsburgh, PA, USA.
Jeffrey A
JA
Linder
University of Pittsburgh, PA, USA.
Scott
S
Beach
RAND Corporation, Boston, MA, USA.
Claude M
CM
Setodji
RAND Corporation, Boston, MA, USA.
Gerald
G
Hunter
RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA Beth Israel Deaconess Medical Center, Boston, MA, USA.
Ateev
A
Mehrotra
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D011795:Surveys and Questionnaires / Q000592:standards
D000900:Anti-Bacterial Agents
acute respiratory tract infection; ambulatory care; antibiotic overuse; antibiotic use; antibiotics