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Utilization of services for otitis media by children enrolled in Medicaid
P J Byrns1, J Bondy, J E Glazner
1Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Insights
This study analyzed otitis media care in young Medicaid patients, finding high ambulatory visit and antibiotic prescription rates. Further research is needed to understand factors influencing treatment quality and quantity.
Area of Science:
- Pediatric Health Services Research
- Epidemiology of Otitis Media
- Health Economics and Policy
Background:
- Otitis media (OM) is a common childhood illness requiring significant healthcare utilization.
- Understanding the patterns of ambulatory visits, antibiotic prescriptions, and surgical procedures for OM is crucial for resource allocation and quality improvement.
Purpose of the Study:
- To provide population-based data on the utilization of healthcare services for otitis media (OM) in children.
- To analyze ambulatory visits, antibiotic prescriptions, and surgical procedures related to OM management.
Main Methods:
- A descriptive study utilizing administrative data from Colorado Medicaid (1991-1992).
- Calculated utilization rates per child and per child-year for children younger than 13 years.
- Stratified rates by age for children with at least one OM-related ambulatory visit.
Main Results:
- Approximately 22% of children had at least one OM-related ambulatory visit, peaking between ages 1-2 years.
- The rate of antibiotic courses for OM was 0.34 per child (0.48/child-year), with an average of 1.55 courses per child diagnosed with OM.
- An annual rate of 12 surgical procedures per 1000 children for OM was observed, with ventilating tube insertions peaking in ages 1-2 years.
Conclusions:
- The study highlights the substantial healthcare utilization for otitis media in young children.
- Findings underscore the need to consider enrollment volatility in insured populations when calculating utilization rates.
- Further research is recommended to explore the impact of factors like healthcare access and physician preferences on OM treatment.
Objective:
To provide population-based information about the utilization of ambulatory visits, antibiotic prescriptions, and surgical procedures related to the diagnosis and management of otitis media.
Design:
A descriptive study in which utilization rates per child and per child-year were calculated. Child-year rates stratified by age were calculated only for children having at least 1 ambulatory visit with a diagnosis of otitis media.
Setting:
Administrative data from Colorado Medicaid for the 1991 and 1992 calendar years.
Patients:
All children enrolled in Medicaid who are younger than 13 years and not participating in a prepaid health care plan during the study years (n = 131,169 and n = 157,065) were included in the analysis.
Results:
Approximately 22% of children made at least 1 ambulatory visit with a diagnosis of otitis media, with the peak prevalence (46.8%) occurring between ages 1 and 2 years. Among all children younger than 13 years enrolled in Medicaid, there were 0.5 ambulatory visits for otitis media per child (0.7 ambulatory visits per child-year), with 70% occurring in a physician office setting, 14.8% in a hospital clinic or community health center, and 15.2% in a hospital emergency department. For all children enrolled in Medicaid, the rate of antibiotic courses for otitis media was 0.34 per child (0.48/child-year). Each child with otitis media had an annual average of 1.55 antibiotic courses (1.82 antibiotic courses per child-year). The average ratio of antibiotic courses to ambulatory visits related to otitis media was 65%. There was an annual rate of 12 surgical procedures related to otitis media per 1000 children (16.6/1000 child-years). The peak rate of ventilating tube insertion occurred in children ages 1 to 2 years and for adenoidectomy in children 3 to 6 years. Mastoidectomy rates were low, 92% occurring in children older than 2 years.
Conclusions:
This study represents preliminary techniques to profile the care of children with otitis media. Our findings support the need to measure volatility of enrollment in an insured population before calculating rates of utilization. Additional research is needed to measure the effects of discontinuous eligibility, access to a regular source of primary care, site of treatment, and physician preferences on the quantity and quality of treatments for otitis media.