{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:50:58Z","timestamp":1782928258870,"version":"3.54.5"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Inappropriate diagnosis of infections results in antibiotic overuse and may delay diagnosis of underlying conditions. Here we describe the development and characteristics of 2 safety measures of inappropriate diagnosis of urinary tract infection (UTI) and community-acquired pneumonia (CAP), the most common inpatient infections on general medicine services.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Measures were developed from guidelines and literature and adapted based on data from patients hospitalized with UTI and CAP in 49 Michigan hospitals and feedback from end-users, a technical expert panel (TEP), and a patient focus group. Each measure was assessed for reliability, validity, feasibility, and usability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Two measures, now endorsed by the National Quality Forum (NQF), were developed. Measure reliability (derived from 24 483 patients) was excellent (0.90 for UTI; 0.91 for CAP). Both measures had strong validity demonstrated through (a) face validity by hospital users, the TEPs, and patient focus group, (b) implicit case review (\u0138 0.72 for UTI; \u0138 0.72 for CAP), and (c) rare case misclassification (4% for UTI; 0% for CAP) due to data errors (&amp;lt;2% for UTI; 6.3% for CAP). Measure implementation through hospital peer comparison in Michigan hospitals (2017 to 2020) demonstrated significant decreases in inappropriate diagnosis of UTI and CAP (37% and 32%, respectively, P &amp;lt; .001), supporting usability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We developed highly reliable, valid, and usable measures of inappropriate diagnosis of UTI and CAP for hospitalized patients. Hospitals seeking to improve diagnostic safety, antibiotic use, and patient care should consider using these measures to reduce inappropriate diagnosis of CAP and UTI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae044","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T08:30:14Z","timestamp":1706776214000},"page":"1403-1411","source":"Crossref","is-referenced-by-count":14,"title":["Development of Patient Safety Measures to Identify Inappropriate Diagnosis of Common Infections"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7775-5696","authenticated-orcid":false,"given":"Andrea T","family":"White","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie M","family":"Vaughn","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah , USA"},{"name":"Division of Health System Innovation & Research, Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City, Utah , USA"},{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A","family":"Petty","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejal N","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer K","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A","family":"Flanders","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System , Ann Arbor, Michigan , USA"},{"name":"Medicine Service, Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, Michigan , USA"},{"name":"Division of General Internal Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy P","family":"Hofer","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System , Ann Arbor, Michigan , USA"},{"name":"Medicine Service, Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, Michigan , USA"},{"name":"Division of General Internal Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ratz","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth S","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawny","family":"Czilok","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Minock","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, 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