Background
Methods/design
Setting/clinic eligibility
University of Wisconsin | University of Utah | |
---|---|---|
Total no. of clinics | 22 | 11 |
No. of intervention clinics | 12 | 6 |
Total no. of providers | 268 | 111 |
GIM clinics | 10 | 2 |
FM clinics | 12 | 4 |
Combined GIM and FM clinics | 0 | 5 |
No. of providers per clinic | 2–29 | 3–23 |
Randomization
Intervention and control groups
Patient inclusion and exclusion criteria
Strep | Pneumonia | Both |
---|---|---|
Reason for visit | ||
Sore throat | Cough and/or chest congestion | |
URI symptoms | ||
Diagnosis | ||
Pharyngitis (ICD-10: J02.9, R07.0) | Cough (ICD-10: RO5) | |
Strep (ICD-10: J02.0, J03.00, J03.01) | URI (ICD-10: J22, J98.8, J06.9) | |
Bronchitis (ICD-10: J20.8, J20.9, J40) | ||
Pneumonia (ICD-10: J13, J18.1, J15.0, J14, J15.4, J15.3, J15.20, J15.211, J15.212, J15.29, J15.5, J15.6, J15.8, J15.9, A48.1, J18.9) | ||
Reason for visit and antibiotic combinationa
| ||
Hoarseness | Fever | |
Diagnosis and antibiotic combinationa
| ||
Laryngitis (ICD-10: J04.0, J04.2, J05.0, J06.0) | Wheezing (ICD-10: R06.2) | Dyspnea/SOB (ICD-10: R06.89, R06.09, R06.00, R06.02) |
Fever (ICD-10: R50.9) | ||
Rhinitis (ICD-10: J00) |
Tool adaptation
Clinical prediction rules
Strep pharyngitis | Pneumonia | ||
---|---|---|---|
Children | Adults | Adults | |
Age range | 3–17 years old | 18–70 years old | 18–70 years old |
Rule | McIsaac [13] | Centor [10] | Heckerling [12] |
Criteria | Tonsillar exudate +1 Tender anterior cervical adenopathy +1 Lack of cough +1 History of fever +1 3–14 years old +1 | Tonsillar exudate +1 Tender anterior cervical adenopathy +1 Lack of cough +1 History of fever +1 | Temperature > 100 F +1 HR > 100 bpm +1 Crackles (rales) +1 Decreased breath sounds +1 Absence of asthma +1 |