Overdiagnosis of Urinary Tract Infections by Nursing Home Clinicians
Nursing homes (NHs) need systems-based interventions to augment clinical decision-making to effectively reduce overdiagnosis of urinary tract infections (UTI), according to authors of a study published by the Journal of American Geriatrics Society.
The study comprised 1748 NH clinicians who responded to 19 randomly selected clinical scenarios via a cross sectional, web-based survey. For each scenario, the clinicians were asked if a UTI was likely and then their responses were compared with clinical guidelines to measure judgment and performance. Half of the clinicians were NH primary care providers, while the other half were NH registered nurses. Those surveyed were 39% male and an average age of 45 years.
Within the 19 provided scenarios, researchers designed 33,212 discrete choice scenarios. The researchers noted that in 66% of all scenarios, correct classification occurred by 70% of providers and 62% of nurses. Survey participants were uncertain about a specific diagnosis in 30% of the scenarios.
Compared to the clinical guideline, overall respondent judgment sensitivity measured 78%, with providers at 81% and nurses at 74%, and a specificity of 54%, with providers at 59%, and nurses at 49%.
“Adjusting for covariates in multivariable models, being a nurse and having higher closemindedness were associated higher odds of false positive UTI (odds ratio [OR] 1.61, P < 0.001; and OR 1.09, P = 0.039, respectively), although higher UTI knowledge and conscientiousness were associated with lower odds of false positive UTI ratings (OR 0.80, P < 0.001; OR 0.90, P = 0.005, respectively),” stated study authors.
Researchers noted these results confirm clinician tendency to over-diagnose UTIs and further research would be needed to better assess how UTI knowledge, clinician type, and personality traits can influence behavior.
Reference:
Kistler CE, Wretman CJ, Zimmerman S, et al. Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline. J Am Geriatr Soc. Published online January 11, 2022. doi: 10.1111/jgs.17638
