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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2015
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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. |
format | Online Article Text |
id | pubmed-4327773 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
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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