{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:32:32Z","timestamp":1789471952053,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["11921828"],"award-info":[{"award-number":["11921828"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["1R01HS024519\u201001"],"award-info":[{"award-number":["1R01HS024519\u201001"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To inform overprescribing and antibiotic stewardship in nursing homes (NHs), we examined the concordance between clinicians' (NH primary care providers and registered nurses) diagnosis of suspected UTI with a clinical guideline treated as the gold standard, and whether clinician characteristics were associated with diagnostic classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross\u2010sectional web\u2010based survey of a U.S. national convenience sample of NH clinicians. The survey included a discrete choice experiment with 19 randomly selected clinical scenarios of NH residents with possible UTIs. For each scenario, participants were asked if they thought a UTI was likely. Responses were compared to the guideline to determine the sensitivity and specificity of clinician judgment and performance indicators. Multivariable logistic mixed effects regression analysis of demographic, work, personality, and UTI knowledge\/attitudes characteristics was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One thousand seven hundred forty\u2010eight NH clinicians responded to 33,212 discrete choice scenarios; 867 (50%) were NH primary care providers and 881 (50%) were NH registered nurses, 39% were male, and the mean age was 45\u2009years. Participants were uncertain about diagnosis in 30% of scenarios. Correct classification occurred for 66% of all scenarios (providers: 70%; nurses: 62%). Respondent judgment had a sensitivity of 78% (providers: 81%; nurses: 74%) and specificity of 54% (providers: 59%; nurses: 49%) compared to the clinical guideline. 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,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; and OR 1.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.039, respectively), although higher UTI knowledge and conscientiousness were associated with lower odds of false positive UTI ratings (OR 0.80,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; OR 0.90,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.005, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinicians tend to over\u2010diagnose urinary tract infections, necessitating systems\u2010based interventions to augment clinical decision\u2010making. Clinician type, UTI knowledge, and personality traits may also influence behavior and deserve further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.17638","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T04:58:22Z","timestamp":1641877102000},"page":"1070-1081","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0566-5741","authenticated-orcid":false,"given":"Christine E.","family":"Kistler","sequence":"first","affiliation":[{"name":"Department of Family Medicine, School of Medicine University of North Carolina  Chapel Hill NC USA"},{"name":"The Cecil G. Sheps Center for Health Services Research University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Wretman","sequence":"additional","affiliation":[{"name":"The Cecil G. Sheps Center for Health Services Research University of North Carolina  Chapel Hill NC USA"},{"name":"School of Social Work University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheryl","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"The Cecil G. Sheps Center for Health Services Research University of North Carolina  Chapel Hill NC USA"},{"name":"School of Social Work University of North Carolina  Chapel Hill NC USA"},{"name":"Gillings School of Global Public Health University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chineme","family":"Enyioha","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, School of Medicine University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Ward","sequence":"additional","affiliation":[{"name":"The Cecil G. Sheps Center for Health Services Research University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire E.","family":"Farel","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D.","family":"Sloane","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, School of Medicine University of North Carolina  Chapel Hill NC USA"},{"name":"The Cecil G. Sheps Center for Health Services Research University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella H.","family":"Boynton","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna S.","family":"Beeber","sequence":"additional","affiliation":[{"name":"School of Nursing University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Preisser","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health University of North Carolina  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2019.11.009"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4070"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.00470.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(86)90391-8"},{"issue":"3","key":"e_1_2_11_6_1","first-page":"273","article-title":"Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? 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