We examined quality of care across different clinical
settings within a large safety-net hospital in Massachusetts for patients
presenting with penile discharge/dysuria or vaginal discharge.
Using a modified Delphi approach, a list of sex-specific
sexually transmitted infection (STI) quality measures, covering 7 domains of
clinical care (history, examination, laboratory testing, assessment, treatment,
additional screening, counseling), was selected as standard of care by a panel
of 5 STI experts representing emergency department (ED), obstetrics/gynecology
(Ob/Gyn), family medicine (FM), primary care (PC), and infectious disease.
Final measures were piloted with 50 charts per sex from the STI Clinic and age,
sex, and visit date-matched charts from PC, FM, ED, and Ob/Gyn. Performance was
scored as compliance among individual measures within 7 domains, standardized
to add up to one to adjust for variable number of measures per domain, with an
overall score of 7 indicating complete adherence to standards.
Expert review process took 2 weeks and resulted in 24 and 34
final measures for male and female patients, respectively. Performance on 7
clinical domains ranged from 3.16 to 4.36 for male patients and 3.17 to 4.33
for female patients. Sexually transmitted infection clinic seemed to score
higher on laboratory testing, additional screening, and counseling, but lower
on examination and assessment, and ED seemed to score higher on examination and
treatment, PC and FM on laboratory testing for male patients and on examination
and treatment for female patients, and Ob/Gyn on treatment.
An instrument to discern standard of care and identify
strengths and weaknesses in specific domains of clinical documentation for
patients presenting with STI complaints can be developed and implemented for
quality evaluation across care settings. Further research is needed on whether
these findings can be integrated into site-specific quality improvement
processes and linked to cost analyses.
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By:
- 1From the *Boston University School of Medicine, Boston, MA; †Massachusetts Department of Public Health, Boston, MA; and ‡Boston University School of Public Health, Boston, MA.
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