Quality Measures for the Care of Children With Otitis Media With Effusion

Lannon, Carole; Peterson, Laura E.; Goudie, Anthony

doi:10.1542/peds.2009-3569

Cited by 27 publications

(33 citation statements)

References 17 publications

(13 reference statements)

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“…Previous work on quality measures for the pediatric population has emphasized the importance of testing measures in the real world settings where care will be assessed. 45 The measurement stage of this study highlighted a number of issues that are relevant to the interpretation and application of the indicators. For example, a challenge identified in the data collection phase was the difficulty assigning time zero for complex conditions such as severe sepsis, DKA, and status epilepticus.…”

Section: Discussionmentioning

confidence: 99%

Quality Indicators for High Acuity Pediatric Conditions

et al. 2013

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OBJECTIVE: Identifying gaps in care and improving outcomes for severely ill children requires the development of evidence-based performance measures. We used a systematic process involving multiple stakeholders to identify and develop evidence-based quality indicators for high acuity pediatric conditions relevant to any emergency department (ED) setting where children are seen. METHODS:A prioritized list of clinical conditions was selected by an advisory panel. A systematic review of the literature was conducted to identify existing indicators, as well as guidelines and evidence that could be used to inform the creation of new indicators. A multiphase, Rand-modified Delphi method consisting of anonymous questionnaires and a face-to-face meeting of an expert panel was used for indicator selection. Measure specifications and evidence grading were created for each indicator, and the feasibility and reliability of measurement was assessed in a tertiary care pediatric ED. RESULTS:The conditions selected for indicator development were diabetic ketoacidosis, status asthmaticus, anaphylaxis, status epilepticus, severe head injury, and sepsis. The majority of the 62 selected indicators reflect ED processes (84%) with few indicators reflecting structures (11%) or outcomes (5%). Thirty-seven percent (n = 23) of the selected indicators are based on moderate or high quality evidence. Data were available and interrater reliability acceptable for the majority of indicators. CONCLUSIONS:A systematic process involving multiple stakeholders was used to develop evidence-based quality indicators for high acuity pediatric conditions. Future work will test the reliability and feasibility of data collection on these indicators across the spectrum of ED settings that provide care for children . Pediatrics 2013;132:752-762

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Section: Discussionmentioning

confidence: 99%

Quality Indicators for High Acuity Pediatric Conditions

et al. 2013

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“…Distinctly impaired mobility of the tympanic membrane on pneumatic otoscopy is highly predict ive of OME 91,100 and improves diagnostic accuracy over otoscopy alone 106,107 . However, the use of pneumatic otoscopy in clinical practice is variable worldwide; in the United States alone, prevalence ranges from 7% to 33% 108,109 . Training medical residents in pneumatic otoscopy is challenging 5 , but can be enhanced with a structured, computerized curriculum with static and dynamic images of the tympanic membrane 94 .…”

Section: Nature Reviews | Disease Primersmentioning

confidence: 99%

Otitis media

Schilder

Chonmaitree

Cripps

et al. 2016

Nat Rev Dis Primers

396

361

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Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.

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“…The key action statement from this guideline, a “strong recommendation to use tympanometry or pneumatic otoscopy in diagnosis of [otitis media with effusion],” was converted to a process measure (ie, how often this procedure was followed). 25(p598) Using this performance measure, Lannon et al 26 were able to show that only 33% of pediatric clinics were following this strongly recommended practice. This finding may be the result, in part, of a failure in documentation since this study was conducted by using a review of medical records.…”

Section: Performance Measure Developmentmentioning

confidence: 99%

Understanding Quality Measures in Otolaryngology–Head and Neck Surgery

Vila

Schneider

Piccirillo

et al. 2016

JAMA Otolaryngol Head Neck Surg

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As health care reimbursements based on pay-for-performance models become more common, there is an unprecedented demand for ways to measure health care quality and demonstrate value. Performance measures, a type of quality measure, are unique tools in a health care delivery system that allow objective monitoring of adherence to specific goals and tracking of outcomes. We sought to provide information on the development of quality measures in otolaryngology–head and neck surgery, as well as the goals of performance measurement at a national level and for our specialty. The historical development, various types, and approach to creating effective performance measures are discussed. The primary methods of developing performance measures (using clinical practice guidelines, clinical registries, and alternative methods) are also discussed. Performance measures are an important tool that can aid otolaryngologists in achieving effective, efficient, equitable, timely, safe, and patient-centered care as outlined by the Institute of Medicine.

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Quality Measures for the Care of Children With Otitis Media With Effusion

Abstract: Coding, case finding, and evaluating appropriateness of treatment are some of the issues that will need to be considered to assess the care of children with OME. This study emphasizes the importance of testing proposed quality of care measures in "real-world" settings.

Cited by 27 publications

References 17 publications

Quality Indicators for High Acuity Pediatric Conditions

Quality Indicators for High Acuity Pediatric Conditions

Otitis media

Understanding Quality Measures in Otolaryngology–Head and Neck Surgery

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