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Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management
Justin Cottrell1, Amirpouyan Namavarian2, Jonathan Yip2
1Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
Insights
This study developed 8 quality indicators (QIs) for pediatric acute otitis media (AOM) to improve care. These QIs address antimicrobial use, referrals, and tympanostomy tube counseling for better patient outcomes.
Area of Science:
- Otolaryngology
- Pediatrics
- Health Services Research
Background:
- Pediatric acute otitis media (AOM) is common, with overdiagnosis and overtreatment posing significant risks.
- Existing quality indicators (QIs) for AOM are limited and often adapted from general respiratory infection guidelines.
- There is a need for specific pediatric AOM QIs to guide quality improvement initiatives.
Purpose of the Study:
- To develop a foundational set of pediatric acute otitis media (AOM) quality indicators.
- To establish benchmarks for high-quality care in the diagnosis and management of pediatric AOM.
- To support future quality improvement efforts aimed at enhancing patient outcomes.
Main Methods:
- A modified RAND/UCLA appropriateness methodology was employed.
- An 11-member expert panel, including otolaryngologists, a pediatrician, and a family physician, participated.
- Candidate indicators were extracted from existing guidelines and position statements.
Main Results:
- Initially, 27 candidate indicators were identified, with one additional indicator developed by the panel.
- Following the first round of evaluations, 4 indicators were deemed appropriate.
- After an expert panel meeting and a second evaluation round, 8 final QIs were established.
- The final QIs cover antimicrobial management, specialty referral, and tympanostomy tube counseling.
Conclusions:
- Variable and substandard care for pediatric AOM persists despite existing guidelines.
- The proposed 8 QIs complement current recommendations for pediatric AOM management.
- These QIs are intended to facilitate quality improvement initiatives and improve patient outcomes.
Background:
The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts.
Methods:
Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology-head and neck surgeons, a pediatrician and family physician.
Results:
Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling.
Conclusions:
Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.
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