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Comparison of Algorithms to Triage Patients to Express Care in a Sexually Transmitted Disease Clinic.

Comparison of Algorithms to Triage Patients to Express Care in a Sexually Transmitted Disease Clinic.
Author Information (click to view)

Chambers LC, Manhart LE, Katz DA, Golden MR, Barbee LA, Dombrowski JC,


Chambers LC, Manhart LE, Katz DA, Golden MR, Barbee LA, Dombrowski JC, (click to view)

Chambers LC, Manhart LE, Katz DA, Golden MR, Barbee LA, Dombrowski JC,

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Sexually transmitted diseases 2018 04 10() doi 10.1097/OLQ.0000000000000854

Abstract
BACKGROUND
The ideal approach to triaging STD clinic patients between testing-only express visits and standard visits with clinician evaluation is uncertain.

METHODS
In this cross-sectional study, we used classification and regression tree analysis to develop and validate the optimal algorithm for predicting which patients need a standard visit with clinician assessment (i.e., to maximize correct triage). Using electronic medical record data, we defined patients as needing a standard visit if they reported STD symptoms, received any empiric treatment, or were diagnosed with an infection or syndrome at the same visit. We considered 11 potential predictors for requiring medical evaluation collected via computer-assisted self-interview (CASI) when constructing the optimized algorithm. We compared test characteristics of the optimized algorithm, the Public Health-Seattle and King County STD Clinic’s current 13-component algorithm, and a simple two-component algorithm including only presence of symptoms and contact to STD.

RESULTS
During 10/2010-06/2015, 18,653 unique patients completed a CASI. In the validation samples, the optimized, current, and simple algorithms appropriately triaged 90%, 85%, and 89% of patients, respectively. The optimized algorithm had lower sensitivity for identifying patients needing standard visits (men: 94%; women: 93%) than the current algorithm (men: 95%; women: 98%), as did the simple algorithm (men: 91%; women: 93%). The optimized, current, and simple algorithms triaged 31%, 23%, and 33% of patients to express visits, respectively.

CONCLUSIONS
The overall performance of the statistically optimized algorithm did not differ meaningfully from a simple two-component algorithm. In contrast, the current algorithm had the highest sensitivity but lowest overall performance.

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