Algorithm-directed care by nonphysician practitioners in a pediatric population: Part I. Adherence to algorithm logic and reproducibility of nonphysician practitioner data-gathering behavior

The ability of quickly trained nonphysician practitioners to care for pediatric patients with upper respiratory tract infections (URIs) was evaluated in 3802 patients. These nonphysician practitioners (Army Pamosists) used an explicit treatment protocol and computerized audit of protocol adherence. Pamosists omitted protocol-suggested plans in 3.7 per cent of cases and ordered unnecessary treatment plans in 1.7 per cent of cases. They did not obtain a suggested MD consultation in 6.2 per cent of the cases. Agreement between Pamosists and pediatricians on data and management decisions (PM-MD study) was then compared with agreement on the same variables between pairs of a group of five pediatricians who saw a separate but comparable group of 103 pediatric URI patients (MD-MD study). The Pamosists demonstrated good (77 to 89 per cent) overall agreement with pediatricians, and the amounts of agreement between Pamosists and pediatricians in the PM-MD study did not generally differ significantly (p greater than 0.05) from the agreement on the same variables between pairs of pediatricians in the MD-MD study.