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.
Inquiry a journal of medical care organization, provision and financing