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Challenges remain for evaluating OME diagnosis and treatment

Lannon C. Pediatrics. 2011;127:e1490-e1497.

Compliance rates for diagnosis and treatment of otitis media with effusion varied among practices, according to recent study results.

However, the researchers said further testing of evaluation measures in real-world settings may be necessary before clinicians can be held accountable for compliance.

Eligible children were aged 2 months to 12 years and had at least one visit with a specified otitis media with effusion (OME) code during the 1-year period between Feb. 1, 2008, and Jan. 31, 2009.

The final analysis included 378 abstractions from 19 practices (range: 3-37 per practice). Fifteen practices had data for fewer than 30 eligible visits.

The rate of diagnostic evaluation using pneumatic otoscopy or tympanometry was 33%, and only 29% of charts reported complete hearing evaluation. The range for hearing evaluation was 0% to 100% across all practices.

Decongestant or antihistamines were used appropriately in 97% of charts. Antibiotics (87%) and corticosteroids (95%) also had high rates of appropriate use. However, antibiotic use concurrent with OME was reported in 35% of records, and only 16% of records that provided a reason for prescribing antibiotics contained an appropriate reason.

The aim of the study was to evaluate the quality of care for children with OME. Researchers from two sites in the US adapted preliminary findings from the Physician Consortium for Performance Improvement to assess compliance with diagnostic, evaluation and treatment measures for the infection.

Data were taken from convenience samples from the Cincinnati Pediatric Research Group and the AAP’s Quality Improvement Innovation Network, both of which are primary care networks.

“Our findings underscore the importance of legislative mandates, such as the Children’s Health Insurance Program Reauthorization Act, to evaluate the measures that will be used to assess the quality of care for children and adolescents,” the researchers wrote. “The findings emphasize the importance of testing measures in the real-world settings where care will be assessed before the metrics are used to hold clinicians accountable.”

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