Deciding not to measure performance: the case of acute otitis media

Area of Science:

• Pediatric infectious diseases
• Health services research
• Quality improvement in healthcare

Background:

• Antibiotic overuse for acute otitis media (AOM) in children is a significant public health concern.
• Existing Health Plan Employer Data and Information Set (HEDIS) measures do not address antibiotic overuse.
• AOM is a common childhood infection requiring careful antibiotic stewardship.

Purpose of the Study:

• To develop a new HEDIS performance measure for appropriate antibiotic use in children with AOM.
• To address the public health threat of antibiotic resistance and overuse.
• To evaluate the feasibility of creating a quality measure for AOM management.

Main Methods:

• The study followed a standard three-phase measure development process: initial development, field-testing, and refinement.
• The development of the AOM measure could not progress beyond the initial phase.
• Challenges related to the relevance and scientific soundness of the proposed measure were encountered.

Main Results:

• The measure development process for appropriate antibiotic use in AOM failed to advance past the initial stage.
• Significant issues concerning the relevance and scientific soundness of the proposed measure were identified.
• The lack of a robust evidence base for AOM diagnosis and management impeded progress.

Conclusions:

• Developing quality performance measures requires adequate scientific evidence and relevance.
• The sparse evidence base for AOM diagnosis and management prevents the establishment of reliable performance standards.
• It is unlikely that sufficient evidence will emerge in the future to support the development of such a quality measure for AOM.