Adherence to Tympanostomy Tube Clinical Practice Guidelines in an Advanced Practice Provider Clinic

Area of Science:

• Otolaryngology
• Pediatric Healthcare
• Evidence-Based Medicine

Background:

• Recurrent acute otitis media (RAOM) is a common pediatric condition requiring guideline-based management.
• The 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) provides recommendations for RAOM treatment.
• Adherence to CPGs ensures optimal patient outcomes and resource utilization.

Purpose of the Study:

• To compare the adherence rates of attending otolaryngologists (OTOs) and advanced practice providers (APPs) to the CPG for RAOM.
• To evaluate the effectiveness of APP-led clinics in managing RAOM.
• To assess agreement between pre-operative and surgical-time middle ear effusion identification.

Main Methods:

• Retrospective review of patients aged 6 months to 12 years undergoing bilateral myringotomy and tympanostomy tube placement (BMT) for RAOM.
• Patients were categorized based on whether they were seen by an OTO or an APP pre-operatively.
• CPG adherence was determined by the presence of middle ear effusion or meeting exception criteria.

Main Results:

• Nine hundred twenty-three patients were included; 601 seen by OTOs and 322 by APPs.
• Middle ear effusion was identified pre-operatively in 84% of APP patients versus 76% of OTO patients (P=.005).
• Overall adherence to CPG or exception criteria was higher for APPs (92%) compared to OTOs (87%) (P=.037). Provider type did not significantly impact agreement between pre-op and surgical-time effusion identification.

Conclusions:

• Independent APP-led clinics can effectively manage RAOM with high adherence to CPGs.
• APP management of RAOM demonstrates comparable or superior adherence rates to CPGs compared to OTOs.
• This supports the integration of APPs in delivering evidence-based care for RAOM.