Acute Infections in Primary Care: Accuracy of Electronic Diagnoses and Electronic Antibiotic Prescribing |
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| Affiliation: | 1. Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA;3. Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan;4. Department of Medicine, Johannes-Gutenberg University Clinic, Mainz, Germany;5. Department of Hemato-Oncology, Clinica San Carlos de Apoquindo, Pontificia Universidad Católica, Santiago, Chile;6. Department of Medical Oncology, Oncovida Cancer Center, Fundación Arturo López Pérez, Providencia, Chile;7. Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Peking University Cancer Hospital and Institute, Beijing, China;8. Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland;9. Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan;10. II Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Medical University of Lublin, Lublin, Poland;11. Department of Medical Oncology, Fundacao Pio Xii Hosp Cancer De Barretos, Barretos, Brazil;12. Department of Medical Oncology, Zhongshan Hospital Fudan University, Shanghai, China;13. Department of Medical Oncology, Sfantul Nectarie Oncology Center, Dolj, Romania;14. Department of Internal Medicine, Oncology Unit, Universidad de La Frontera, Temuco, Chile;15. Hematology-Oncology, Oncology Center–Centre Hospitalier de l''Universite de Montreal, Montreal, QC, Canada;p. Instituto Multidisciplinario de Oncologia, Clinica Viedma SA, Viedma, Argentina;q. Department of Biological Chemistry and Laiko General Hospital Medical School, National and Kapodistrian University of Athens, Athens, Greece;r. Internal Medicine, Clinical Oncology, Instituto Nacional de Cancerología Empresa Social del Estado, Bogotá, Colombia;s. Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düesseldorf, University Hospital of Cologne, Cologne, Germany;t. Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain;u. Department of Chemotherapy, National Institute of Oncology, Budapest, Hungary;v. Department of Oncology, Haematology and Palliative Care, St John of God Murdoch Hospital, Murdoch, WA, Australia;w. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA;x. Bristol Myers Squibb, Princeton, NJ, USA;y. Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;1. Imperial College London, Du Cane Road, London W12 0HS, United Kingdom;2. Infection Control Programme, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;3. Department of Surgery and Cancer, St Mary''s Hospital, Norfolk Place, London W2 1PG, United Kingdom;1. Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Kita-ku, Okayama, 7008530, Japan;2. Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 5650871, Japan;3. Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 7008558, Japan;4. Data Science Division, Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 7008558, Japan;5. Department of Pharmaceutical Biomedicine, Graduate School of Interdisciplinary Science and Engineering in Health Systems, 1-1-1 Tsushima-naka, Kita-ku, Okayama, 7008530, Japan;6. Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima, 7708503, Japan;7. Department of Pharmaceutical Care and Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, 180 Nishihamabouji Yamashiro-cho, Tokushima, 7708514, Japan;8. Department of Biostatistics, Sapporo Medical University, South 1, West 17, Chuo-ku, Sapporo, Hokkaido, 0608556, Japan |
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| Abstract: | ObjectiveTo maximize effectiveness, clinical decision-support systems must have access to accurate diagnostic and prescribing information. We measured the accuracy of electronic claims diagnoses and electronic antibiotic prescribing for acute respiratory infections (ARIs) and urinary tract infections (UTIs) in primary care.DesignA retrospective, cross-sectional study of randomly selected visits to nine clinics in the Brigham and Women's Practice-Based Research Network between 2000 and 2003 with a principal claims diagnosis of an ARI or UTI (N = 827).MeasurementsWe compared electronic billing diagnoses and electronic antibiotic prescribing to the gold standard of blinded chart review.ResultsClaims-derived, electronic ARI diagnoses had a sensitivity of 98%, specificity of 96%, and positive predictive value of 96%. Claims-derived, electronic UTI diagnoses had a sensitivity of 100%, specificity of 87%, and positive predictive value of 85%. According to the visit note, physicians prescribed antibiotics in 45% of ARI visits and 73% of UTI visits. Electronic antibiotic prescribing had a sensitivity of 43%, specificity of 93%, positive predictive value of 90%, and simple agreement of 64%. The sensitivity of electronic antibiotic prescribing increased over time from 22% in 2000 to 58% in 2003 (p for trend < 0.0001).ConclusionClaims-derived, electronic diagnoses for ARIs and UTIs appear accurate. Although closing, a large gap persists between antibiotic prescribing documented in the visit note and the use of electronic antibiotic prescribing. Barriers to electronic antibiotic prescribing in primary care must be addressed to leverage the potential that computerized decision-support systems offer in reducing costs, improving quality, and improving patient safety. |
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