Chambers Laura C, Manhart Lisa E, Katz David A, Golden Matthew R, Barbee Lindley A, Dombrowski Julia C
From the *Department of Epidemiology, †Department of Global Health, ‡Department of Medicine, University of Washington; and §Public Health-Seattle and King County HIV/STD Program, Seattle, WA.
Sex Transm Dis. 2017 Sep;44(9):571-576. doi: 10.1097/OLQ.0000000000000643.
Many sexually transmitted disease (STD) clinics offer testing-only "express" visits. We evaluated the express care triage algorithm that is based on a computer-assisted self-interview (CASI) used in the Public Health-Seattle and King County STD Clinic.
During the analysis period, patients received a clinician evaluation irrespective of triage status. In this cross-sectional study, we compared the algorithm triage status to a disease-focused outcome determined by medical record review. We defined a patient as "needing a standard visit" if they reported key symptoms, received empiric treatment, or were diagnosed with an infection or syndrome at the same visit. We estimated the sensitivity of the algorithm for identifying patients who needed a standard visit and identified the characteristics of patients who could have received express care but were excluded from it by the algorithm.
Between October 2010 and June 2015, patients completed a CASI at 32,113 visits; 23% were triaged by the algorithm to express care. The triage status was appropriate for 21,337 (87%) men and 6259 (82%) women. The algorithm had 95% and 98% sensitivity for identifying men and women, respectively, needing standard visits. The most common reason for mistriage to express care was patient report of symptoms to clinicians that they did not disclose to the CASI. Of women who could have received express care, only 33% were triaged to it by the algorithm; the remainder was triaged to standard visits, primarily for health service indications.
The CASI-based algorithm accurately identified patients who were eligible for express care based on a disease-focused outcome.
许多性传播疾病（STD）诊所提供仅进行检测的“快速”就诊服务。我们评估了基于计算机辅助自我访谈（CASI）的快速护理分诊算法，该算法应用于西雅图和金县公共卫生STD诊所。
在分析期间，无论分诊状态如何，患者均接受临床医生评估。在这项横断面研究中，我们将算法分诊状态与通过病历审查确定的以疾病为重点的结果进行比较。如果患者报告了关键症状、接受了经验性治疗或在同一次就诊时被诊断出感染或综合征，我们将其定义为“需要标准就诊”。我们估计了该算法识别需要标准就诊患者的敏感性，并确定了本可接受快速护理但被该算法排除在外的患者特征。
2010年10月至2015年6月期间，患者在32113次就诊中完成了CASI；23%被该算法分诊为快速护理。分诊状态对21337名（87%）男性和6259名（82%）女性是合适的。该算法识别需要标准就诊的男性和女性的敏感性分别为95%和98%。被误分诊为快速护理的最常见原因是患者向临床医生报告了他们未向CASI披露的症状。在本可接受快速护理的女性中，只有33%被该算法分诊为此类；其余的被分诊为标准就诊，主要是出于健康服务指征。
基于CASI的算法根据以疾病为重点的结果准确识别了符合快速护理条件的患者。
