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Evaluation of an Automated Express Care Triage Model to Identify Clinically Relevant Cases in a Sexually Transmitted Disease Clinic

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

The CASI-based algorithm accurately identified patients who were eligible for express care based on a disease-focused outcome.

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