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

• Main Authors: Courtney A. Gidengil MD, MPH (Author), Jeffrey A. Linder MD, MPH (Author), Scott Beach PhD (Author), Claude M. Setodji PhD (Author), Gerald Hunter MS (Author), Ateev Mehrotra MD, MPH (Author)
• Format: Book
• Published: SAGE Publishing, 2016-03-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

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.

Item Description

0046-9580
1945-7243
10.1177/0046958016636531