Variation in Otitis Media Treatment Index by Location and Sociodemographic Groups in Pediatric Urgent Cares

Antibiotic use is often driven by overdiagnosis. Otitis media is the most common diagnosis for which antibiotics are prescribed in pediatrics. Otitis Media Treatment Index (OMTI) measures the proportion of acute respiratory infections (ARIs) that have a diagnosis of otitis media (OM) and an antibiotic prescription. We explored variation in OMTI from our national pediatric urgent care (PUC) quality improvement (QI) collaborative across sites and by patient characteristics.

This secondary analysis included 24 PUC centers from 6 healthcare organizations representing all 4 regions of the United States. We analyzed encounters of patients aged 6-59 months with diagnoses of ARIs from April 2022 to October 2024. We calculated OMTI defined as the number of ARI encounters with OM diagnosis and antibiotic prescribed divided by all ARI encounters for the collaborative and each PUC center. We examined variability across age, race, and payor type.

Among 456,748 ARI encounters, the overall OMTI index was 35.8% (n=163,686), with ranges from 9 to 50% across centers. The West region had the lowest OMTI (28.4%) while the Northeast and Midwest had the highest OMTIs (40.1% and 40.8%). Patient with commercial insurance had a higher OMTI (37.5%) than other payor types. White patients had the highest OMTI (38.7%) compared to other races. OMTI steadily increased between 6 months of age, peaking at 40.9% at 13 months, and then steadily decreased to 33.5% at 59 months.

OMTI varied substantially by PUC site and patient subgroups suggesting inconsistent OM diagnosis and antibiotic prescribing practices in PUCs. Using OMTI as a benchmark could identify populations at risk of OM overdiagnosis and antibiotic overuse and may help identify opportunities for diagnostic stewardship interventions and more appropriate antibiotic prescribing in PUC.