Using clinical vignettes to assess quality of care for acute respiratory infections

Courtney A. Gidengil*, Jeffrey A. Linder, Scott Beach, Claude M. Setodji, Gerald Hunter, Ateev Mehrotra

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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.

Original languageEnglish (US)
JournalInquiry (United States)
Issue number1
StatePublished - 2016


  • Acute respiratory tract infection
  • Ambulatory care
  • Antibiotic overuse
  • Antibiotic use
  • Antibiotics

ASJC Scopus subject areas

  • Health Policy


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