Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management

Justin Cottrell¹, Amirpouyan Namavarian², Jonathan Yip², Paolo Campisi², Neil K Chadha³, Ali Damji⁴, Paul Hong⁵, Sophie Lachance⁶, Darren Leitao⁷, Lily H P Nguyen⁸, Natasha Saunders⁹, Julie Strychowsky¹⁰, Warren Yunker¹¹, Jean-Philippe Vaccani¹², Yvonne Chan², John R de Almeida², Antoine Eskander², Ian J Witterick², Eric Monteiro²

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
² Department of Otolaryngology-Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada.
³ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax, NS, Canada.
⁶ Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale, CHUL, Pavillon Ferdinand-Vandry, Université Laval, Québec, QC, Canada.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada.
⁸ Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada.
⁹ Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Western University, London Health Sciences Centre-Victoria Hospital, London, ON, Canada.
¹¹ Section of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
¹² Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.

PMID: 38888942
PMCID: PMC11098001
DOI: 10.1177/19160216241248538

Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management

Justin Cottrell et al. J Otolaryngol Head Neck Surg. 2024 Jan-Dec.

. 2024 Jan-Dec:53:19160216241248538.

doi: 10.1177/19160216241248538.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
² Department of Otolaryngology-Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada.
³ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax, NS, Canada.
⁶ Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale, CHUL, Pavillon Ferdinand-Vandry, Université Laval, Québec, QC, Canada.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada.
⁸ Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada.
⁹ Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Western University, London Health Sciences Centre-Victoria Hospital, London, ON, Canada.
¹¹ Section of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
¹² Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.

PMID: 38888942
PMCID: PMC11098001
DOI: 10.1177/19160216241248538

Abstract

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.

Keywords: acute otitis media; infectious diseases; otitis media; quality; quality improvement; quality indicators.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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References

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Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management

Affiliations

Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management

Authors

Affiliations

Abstract

Conflict of interest statement

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References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical