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Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.

ABSTRACT: 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.

SUBMITTER: Gidengil CA

PROVIDER: S-EPMC4840477 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.

Gidengil Courtney A CA Linder Jeffrey A JA Beach Scott S Setodji Claude M CM Hunter Gerald G Mehrotra Ateev A

Inquiry : a journal of medical care organization, provision and financing 20160420

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 mea ...[more]

PMID: 27098876

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Project description:ImportanceThe effectiveness of in-room air purification for the reduction of acute respiratory infections (ARIs) in residential aged-care facilities (RACFs) is unknown.ObjectiveTo investigate the effectiveness of in-room air purifiers with high-efficiency particulate air (HEPA)-14 filters in reducing the incidence of ARIs among residents of RACFs.Design, setting, and participantsThis randomized clinical trial used a multicenter, double-blind, 2-period, 2-treatment crossover design for 6 months from April 7 to October 26, 2023, in 3 RACFs with a bed capacity of 50 to 100 in New South Wales, Australia. The purposive sampling approach included permanent residents in private rooms in the enrolled RACFs. Data collection was performed every 2 weeks and required no additional follow-up beyond the final data collection on October 31, 2023.InterventionAn air purifier containing a HEPA-14 filter was placed in rooms of participants in the intervention group, and an air purifier without a HEPA-14 filter was placed in rooms of the control participants. The groups crossed over after 3 months.Main outcomes and measuresThe primary outcome was the incidence of ARIs, assessed with logistic mixed-model regression.ResultsAmong 135 participants randomized (70 to the intervention-first group and 65 to the control-first group), 78 (57.8%) were female; mean (SD) age was 85.2 (8.6) years. In the intention-to-treat analysis, the use of air purifiers with HEPA-14 filters did not reduce ARIs compared with the control (OR, 0.57; 95% CI, 0.32-1.04; P = .07). Among the 104 participants who completed the entire study, the intervention reduced ARI incidence from 35.6% (37 participants) in the control group to 24.0% (25 participants) in the intervention group (OR, 0.53; 95% CI, 0.28-1.00; P = .048).Conclusions and relevanceIn this clinical trial investigating use of air purifiers with HEPA-14 filters for reducing ARIs, no significant between-group difference was found in the intention-to-treat analysis. However, a significant reduction in ARIs was identified among participants who completed the entire study. These findings may help inform future large-scale studies of respiratory infectious diseases.Trial registrationANZCTR identification: ACTRN12623000347662.

Project description:BackgroundA significant determinant of population health outcomes is the quality of care provided for noncommunicable diseases, obstetric, and pediatric care. We present results on clinical practice quality in these areas as measured among nearly 4,000 providers working at more than 1,000 facilities in 6 Eastern European and Central Asian countries.MethodsThis study was conducted between March 2011 and April 2013 in Albania, Armenia, Georgia, Kazakhstan, Kirov Province in Russia, and Tajikistan. Using a probability proportional-to-size sampling technique, based on number of hospital beds, we randomly selected within each country 42 hospitals and their associated primary health care clinics. Physicians and midwives within each clinical area of interest were randomly selected from each hospital and clinic and asked how they would care for simulated patients using Clinical Performance and Value (CPV) vignettes. Facility administrators were also asked to complete a facility survey to collect structural measures of quality. CPV vignettes were scored on a scale of 0% to 100% for each provider. We used descriptive statistics and t tests to identify significant differences in CPV scores between hospitals and clinics and rural vs. urban facilities, and ANOVA to identify significant differences in CPV scores across countries.ResultsWe found that quality of care, as concurrently measured by performance on CPV vignettes, was generally poor and widely variable within and between countries. Providers in Kirov Province, Russia, had the highest overall performance, with an average score of 70.8%, while providers in Albania and Tajikistan had the lowest average score, each at 50.8%. The CPV vignettes with the lowest scores were for multiple noncommunicable disease risk factors and birth asphyxia. A considerable proportion (11%) of providers performed well on the CPV vignettes, regardless of country, facility, or structural resources available to them.ConclusionsCountries of Eastern Europe and Central Asia are challenged by poor performance as measured by clinical care vignettes, but there is potential for provision of high-quality care by a sizable proportion of providers. Large-scale assessments of quality of care have been hampered by the lack of effective measurement tools that provide generalizable and reliable results across diverse economic, cultural, and social settings. The feasibility of quality measurement using CPV vignettes in these 6 countries and the ability to combine results with individual feedback could significantly enhance strategies to improve quality of care, and ultimately population health.

Project description:BackgroundSevere childhood pneumonia requires treatment in hospital by trained health care workers. It is therefore important to determine if health facilities provide quality health services for children with acute respiratory infections (ARI), including pneumonia. Using established indicators from WHO to measure quality of care (QoC) as a reference standard, this review aims to evaluate how well existing tools assess QoC for children presenting to health facilities with ARI.MethodsExisting assessment tools identified from a published systematic literature review that evaluated QoC assessment tools for children (<15 years) in health facilities for all health conditions were included in this ARI-specific review. 27 ARI-specific indicators or "quality measures" from the WHO "Standards for improving quality of care for children and young adolescents in health facilities" were selected for use as a reference standard to assess QoC for children presenting to health facilities with ARI symptoms. Each included assessment tool was evaluated independently by two paediatricians to determine how many of the WHO ARI quality measures were assessable by the tool. The assessment tools were then ranked in order of percentage of ARI quality measures assessable.ResultsNine assessment tools that assessed QoC for children attending health facilities were included. Two hospital care tools developed by WHO had the most consistency with ARI-specific indicators, assessing 22/27 (81.5%) and 20/27 (74.1%) of the quality measures. The remaining tools were less consistent with the ARI-specific indicators, including between zero to 16 of the 27 quality measures. The most common indicators absent from the tools were assessment of appropriate use of pulse oximetry and administration of oxygen, how often oxygen supply was unavailable, and mortality rates.ConclusionsThe existing WHO hospital-based QoC assessment tools are comprehensive but could be enhanced by improved data quality around oxygen availability and appropriate use of pulse oximetry and oxygen administration. Any tools, however, should be considered within broader assessments of QoC, rather than utilised in isolation. Further adaptation to local settings will improve feasibility and facilitate progress in the delivery of quality health care for children with ARI.RegistrationThe protocol of the original systematic review was registered in PROSPERO ID: CRD42020175652.

Project description:BackgroundTo evaluate the clinical utility of targeted next-generation sequencing (tNGS) for pathogen detection of pediatric acute lower respiratory tract infections (ALRTIs), with a particular focus on the use of throat swab samples.MethodsIn this diagnostic accuracy study involving 132 children, throat swabs and bronchoalveolar lavage fluid (BALF) samples were collected and analyzed by tNGS, and the results were compared with those obtained from conventional diagnostic methods. The impact of prior antibiotic use on the detection rate of tNGS was evaluated, the consistency between throat swabs and BALF was assessed, and the economic cost and invasiveness of the sampling methods were examined.ResultsThis study enrolled 132 children, of whom 79 (60%) were boys and 53 (40%) were girls. Ninety-two (70%) of the patients had fever, and 128 (97%) had a cough. The detection rates of bacteria, viruses, and atypical pathogens in BALF samples by tNGS were 89.5% (n = 68), 98.2% (n = 108), and 77.8% (n = 63), respectively. Compared to traditional detection methods, tNGS showed significantly higher detection rates for bacteria and viruses (P < 0.001), but there was no statistically significant difference in the detection of atypical pathogens (P = 0.59). The use of antibiotics had no significant effect on bacterial detection by tNGS (P = 0.237). Using BALF-tNGS as the "gold standard," the sensitivities of tNGS of throat swabs for detecting bacteria, viruses, and atypical pathogens were 95.83%, 88.16%, and 92.06%, respectively, with specificities of 55.95%, 83.93%, and 100%. In the analysis of economic costs and invasiveness, the cost of throat swab sampling was significantly lower than that of BALF sampling, and the associated pain score and complication rate were significantly lower (P < 0.05).ConclusionstNGS with throat swabs offers higher sensitivity and specificity than traditional methods for diagnosing pediatric ALRTIs. As such, it offers a less invasive, more cost-effective alternative to BALF sampling.

Dataset Information

Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.

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Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections.

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