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Quality measures need to be field-tested, researchers find

A group of researchers has developed a set of "quality indicators" to measure the quality of antibiotic use in hospitalized patients with lower respiratory tract infections (LRTIs) by combining scientific evidence with expert opinion, according to an article in the August 15 issue of Clinical Infectious Diseases, now available online. However, the researchers found that simply developing the quality indicators was not enough: field-testing was also necessary, as some indicators approved by an expert panel proved unworkable in daily practice.

Antibiotics are prescribed to more than two-thirds of patients with LRTIs in Europe and the United States. Over-prescribing and inappropriate use of antibiotics can result in bacterial drug resistance, a burgeoning problem in medicine. The creation and application of effective indicators that would tell physicians when and how to prescribe antibiotics could contribute to more effective treatment of LRTIs and lessen the risk of promoting drug resistance. Insurance companies and federal government programs are moving toward linking physician payments to quality indicators.

Researchers in the Netherlands developed a set of quality indicators for antibiotic use in LRTI by combining recommendations from published guidelines and the available literature and investigating the scientific evidence to determine how well each performed. A panel of experts then judged the indicators' relevance to patient health, reduction of drug resistance and cost-effectiveness. The best indicators combine "the available evidence and expert opinion to assess aspects of care for which evidence alone is insufficient, absent or methodologically weak," according to Jeroen A. Schouten, MD, of Radboud University Nijmegen Medical Centre and lead author of the article.

Establishing the indicators' practical applicability to patient care was the final step. The indicators were tested for measurability, reliability, opportunity for improveme
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Contact: Steve Baragona
sbaragona@idsociety.org
703-299-0412
Infectious Diseases Society of America
11-Jul-2005


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