Quality measures for the care of children with otitis media with effusion

Abstract

Background: Current national efforts provide an opportunity to integrate performance measures into clinical practice and improve outcomes for children.

Objective: The goal of this study was to explore issues in developing and testing measures of care for children with otitis media with effusion (OME).

Methods: We assessed compliance with diagnostic, evaluation, and treatment measures for OME adapted from preliminary work of the Physician Consortium for Performance Improvement, using chart data in a convenience sample of practices from 2 primary care networks (Cincinnati Pediatric Research Group and the American Academy of Pediatrics Quality Improvement Innovation Network). Children aged 2 months to 12 years with at least 1 visit with a specified OME code during a 1-year period were included.

Results: Of 23 practices, 4 could not locate eligible visits. Nineteen practices submitted 378 abstractions (range: 3-37 per practice) with 15 identifying <30 eligible visits. Performance on diagnosis (33%) and hearing evaluation (29%) measures was low but high on measures of appropriate medication use (97% decongestant/antihistamine, 87% antibiotics, and 95% corticosteroids). Thirty-five percent of records documented antibiotic use concurrent with OME; only 16% of the 94 cases that cited reason for prescribing were appropriate. Using methods that consider appropriate clinical action, a more accurate rate for appropriate use of antibiotics was 68%.

Conclusions: Coding, case finding, and evaluating appropriateness of treatment are some of the issues that will need to be considered to assess the care of children with OME. This study emphasizes the importance of testing proposed quality of care measures in "real-world" settings.

FIGURE 1

Frequency and rates of antimicrobial prescribing and reasons cited. ENT indicates ear, nose, and throat specialist.