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The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better

For many surgeries and high-risk medical conditions, higher volume providers provide higher quality care. The impact of volume on more common medical conditions such as acute respiratory infections (ARIs) has not been examined. Using electronic health record data for adult ambulatory ARI visits, we...

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Autores principales: Gidengil, Courtney A., Linder, Jeffrey A., Hunter, Gerald, Setodji, Claude, Mehrotra, Ateev
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327773/
https://www.ncbi.nlm.nih.gov/pubmed/25672338
http://dx.doi.org/10.1177/0046958015571130
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author Gidengil, Courtney A.
Linder, Jeffrey A.
Hunter, Gerald
Setodji, Claude
Mehrotra, Ateev
author_facet Gidengil, Courtney A.
Linder, Jeffrey A.
Hunter, Gerald
Setodji, Claude
Mehrotra, Ateev
author_sort Gidengil, Courtney A.
collection PubMed
description For many surgeries and high-risk medical conditions, higher volume providers provide higher quality care. The impact of volume on more common medical conditions such as acute respiratory infections (ARIs) has not been examined. Using electronic health record data for adult ambulatory ARI visits, we divided primary care physicians into ARI volume quintiles. We fitted a linear regression model of antibiotic prescribing rates across quintiles to assess for a significant difference in trend. Higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. Physicians with a higher volume of cases manage ARI very differently and are more likely to prescribe antibiotics. When they prescribe an antibiotic for a diagnosis for which an antibiotic may be indicated, they are less likely to prescribe guideline-concordant antibiotics. Given that high-volume physicians account for the bulk of ARI visits, efforts targeting this group are likely to yield important population effects in improving quality.
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spelling pubmed-43277732016-02-10 The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better Gidengil, Courtney A. Linder, Jeffrey A. Hunter, Gerald Setodji, Claude Mehrotra, Ateev Inquiry Research Letter For many surgeries and high-risk medical conditions, higher volume providers provide higher quality care. The impact of volume on more common medical conditions such as acute respiratory infections (ARIs) has not been examined. Using electronic health record data for adult ambulatory ARI visits, we divided primary care physicians into ARI volume quintiles. We fitted a linear regression model of antibiotic prescribing rates across quintiles to assess for a significant difference in trend. Higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. Physicians with a higher volume of cases manage ARI very differently and are more likely to prescribe antibiotics. When they prescribe an antibiotic for a diagnosis for which an antibiotic may be indicated, they are less likely to prescribe guideline-concordant antibiotics. Given that high-volume physicians account for the bulk of ARI visits, efforts targeting this group are likely to yield important population effects in improving quality. SAGE Publications 2015-02-10 /pmc/articles/PMC4327773/ /pubmed/25672338 http://dx.doi.org/10.1177/0046958015571130 Text en © The Author(s) 2015 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm).
spellingShingle Research Letter
Gidengil, Courtney A.
Linder, Jeffrey A.
Hunter, Gerald
Setodji, Claude
Mehrotra, Ateev
The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better
title The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better
title_full The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better
title_fullStr The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better
title_full_unstemmed The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better
title_short The Volume-Quality Relationship in Antibiotic Prescribing: When More Isn’t Better
title_sort volume-quality relationship in antibiotic prescribing: when more isn’t better
topic Research Letter
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327773/
https://www.ncbi.nlm.nih.gov/pubmed/25672338
http://dx.doi.org/10.1177/0046958015571130
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