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Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims

Mirabelle Sajisevi1, Kristine Schulz1, Derek D Cyr2

  • 11 Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|September 15, 2016
PubMed

Insights

Before the 2013 guideline, nonadherence to pressure equalization tube (PET) placement recommendations was low to moderate. Analysis of large databases helps measure adherence to clinical practice guidelines.

Area of Science:

  • Otolaryngology
  • Health Services Research
  • Pediatric Medicine

Background:

  • Clinical practice guidelines (CPGs) aim to standardize care.
  • Assessing adherence to CPGs is crucial for quality improvement.
  • Previous adherence rates for pressure equalization tube (PET) placement were not well-established.

Purpose of the Study:

  • To estimate the nonadherence rate for pressure equalization tube (PET) placement before the 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation CPG.
  • To identify areas for quality improvement in otitis media (OM) management.

Main Methods:

  • Analysis of Truven Health MarketScan Research Databases (2010-2012).
  • Identification of children (≤12 years) with OM-related diagnoses.
  • Extrapolation of adherence and nonadherence rates using administrative codes from CPG key action statements (KASs).

Main Results:

  • Over 9.7 million OM-related visits among 3.7 million children were analyzed.
  • Nonadherence to KAS 1 (PET placement for OM with effusion <3 months) was 2.9%.
  • 52.1% of PET placements for OM with effusion >3 months had concurrent hearing loss codes; 48.3% without hearing loss had codes indicating speech/language/learning problem risks.

Conclusions:

  • Low to moderate nonadherence rates to PET placement guidelines were observed prior to CPG dissemination.
  • Heterogeneity in nonadherence rates by region, age, and season was noted.
  • Large administrative and clinical databases offer valuable insights for measuring CPG adherence.

Keywords:
AAO-HNSF clinical practice guidelineMarketScanguideline complianceotitis mediatympanostomy tubes

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