Measuring quality of care for middle ear infection has many pitfalls
Using data from multiple pediatric practices to measure the quality of care for painful inner ear infections (otitis media with effusion [OME]), uncovers a number of problems that may require changes in the quality measures or how they are calculated, according to a new study. OME is common, resulting in an estimated 2.2 million episodes and $4.0 billion in costs each year.
Data from 19 participating practices in 10 States across the United States revealed suboptimal average percentages for proper diagnosis of youngsters seen for possible OME (33 percent use of pneumatic otoscopy or tympanometry to diagnose OME) and proper evaluation (29 percent of patients meeting current guidelines set for hearing evaluation). This contrasted with the high average percentages for avoidance of inappropriate use of three classes of medications (97 percent for avoiding inappropriate use of antihistamines or decongestants, 87 percent for avoiding inappropriate use of systemic antibiotics, and 95 percent for avoiding inappropriate use of systemic corticosteroids). However, further analysis of the antibiotic score suggested the true value was likely much lower.
Among 375 charts reviewed for use of antibiotics, 131 (35 percent) patients with a diagnosis of OME were taking antibiotics concurrently. However, 94 (70 percent) of these patients had reasons documenting their use of antibiotics, 15 legitimately, while the rest represented either use of a wrong diagnostic code or probable inappropriate antibiotic use. An additional 37 patients had no documented reason for being prescribed an antibiotic.
The findings were based on chart data from pediatric practices belonging to either of two primary care research networks. The study was funded in part by the Agency for Healthcare Research and Quality (HS16957) to the Cincinnati Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit http://www.certs.hhs.gov.
More details are in "Quality measures for the care of children with otitis media with effusion," by Carole Lannon, M.D., M.P.H., Laura E. Peterson, B.S.N., M.S., and Anthony Goudie, Ph.D., in the June 2011 Pediatrics 127(6), pp. e1490-e1497.
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