title: Effect of a Dengue Clinical Case Management Course on Physician Practices in Puerto Rico.
abstract: BACKGROUND
  Prior to 2010, the clinical management of dengue in Puerto Rico was inconsistent with World Health Organization guidelines. A 4-hour classroom-style course on dengue clinical management was developed in 2009 and mandated for Puerto Rico medical licensure in 2010. Fifty physicians were trained as "master trainers" and gave this course to 7638 physicians. This study evaluated the effect of the course on the clinical management of hospitalized dengue patients.
  
  
  METHODS
  Pre- and post-course test responses were compared. Changes in physician practices were assessed by reviewing medical records of 430 adult and 1075 pediatric dengue patients at the 12 hospitals in Puerto Rico that reported the most cases during 2008-2009 (pre-intervention) and 2011 (post-intervention). Mixed-effects logistic regression was used to compare key indicators of dengue management.
  
  
  RESULTS
  Physician test scores increased from 48% to 72% correct. Chart reviews showed that the percentage of adult patients who did not receive corticosteroids increased from 30% to 68% (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.7-9.5) and from 91% to 96% in pediatric patients (OR, 2.7; 95% CI, 1.5-4.9). Usage of isotonic intravenous saline during the critical period increased from 57% to 90% in adult patients (OR, 6.2; 95% CI, 1.9-20.4) and from 25% to 44% in pediatric patients (OR, 3.4; 95% CI, 2.2-5.3).
  
  
  CONCLUSIONS
  Management of dengue inpatients significantly improved following implementation of a classroom-style course taught by master trainers. An online version of the course was launched in 2014 to expand its reach and sustainability.
authors: Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
authors: George S
authors: GS
authors: Han
authors: Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
authors: Christopher J
authors: CJ
authors: Gregory
authors: Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors: Brad J
authors: BJ
authors: Biggerstaff
authors: Office of the Director, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors: Kalanthe
authors: K
authors: Horiuchi
authors: Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
authors: Carmen
authors: C
authors: Perez-Guerra
authors: Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
authors: Eunice
authors: E
authors: Soto-Gomez
authors: Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
authors: Desiree
authors: D
authors: Matos
authors: Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
authors: Harold S
authors: HS
authors: Margolis
authors: Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
authors: Kay M
authors: KM
authors: Tomashek
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011647:Puerto Rico; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D007552:Isotonic Solutions
keywords: Puerto Rico; clinical management; dengue; evaluation; key informant interview