Acute Otitis Media - Appropriate First-line Antibiotics

Measure is used to assess the proportion of antibiotics prescribed to patients aged 2 months to 12 years with a diagnosis of Acute Otitis Media (AOM) that were adherent to the AAP/AAFP recommendation for first-line use of amoxicillin

Diagnosis: Acute Otitis Media

Encounter, Performed: Ambulatory/ED Visit

Medication, Order: Antibiotics

Patient Characteristic: birth date

Medication, Order: Common Antibiotics for other infections

Encounter, Performed: Face to Face Interaction - No ED

Diagnosis: Occurrence of Acute Otitis Media

Diagnosis: Occurrence of competing condition or conditions with Acute Otitis Media

Encounter, Performed: Office Visit

Encounter, Performed: Office Visit

Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17

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None

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Otitis Media (OM) is a hallmark disease of pediatrics, with 80% of cases occurring among children (Culpepper 1993).  It is the third most common reason for a pediatric visit, behind preventative care and upper respiratory infections (Hing 2006), and the most common condition pediatricians refer to specialists (Forrest 1999).  Primary care (Froom 1990) and subspecialists physicians (Adeli 2008) have difficulty with diagnosing OM, which contributes to variability in the incidence rates and overuse of antibiotics (Lyon 1998).  It is the most common reason for prescribing antibiotics in the United States (McCaig 1995) and is responsible for about half the antibiotic prescriptions for children ages 3-60 months.  Despite nationally promulgated guidelines (Pediatrics, 2004, Coco 2010), that recommended judicious use of antimicrobials, physicians have been reluctant to alter their rates of prescribing antibiotics for OM (Forrest 2013).

Higher scores indicates better quality

Culpepper L, Froom J, Bartelds AI, et al. Acute otitis media in adults: a report from the International Primary Care Network. J Am Board Fam Pract. Jul-Aug 1993;6(4):333-339.

Hing E, Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2004 summary. Adv Data. Jun 23 2006(374):1-33.

Forrest CB, Glade GB, Baker AE, Bocian AB, Kang M, Starfield B. The pediatric primary-specialty care interface: how pediatricians refer children and adolescents to specialty care. Arch Pediatr Adolesc Med. Jul 1999;153(7):705-714.

Froom J, Culpepper L, Grob P, et al. Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. BMJ. Mar 3 1990;300(6724):582-586.

Adeli M, Bender MJ, Sheridan MJ, Schwartz RH. Antibiotics for simple upper respiratory tract infections: a survey of academic, pediatric, and adult clinical allergists. Ann Allergy Asthma Immunology. Apr 2008;100(4):377-383.

Lyon JL, Ashton A, Turner B, Magill M. Variation in the diagnosis of upper respiratory tract infections and otitis media in an urgent medical care practice. Arch Fam Med. May-Jun 1998;7(3):249-254.

McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. Jan 18 1995;273(3):214-219.

Diagnosis and management of acute otitis media. Pediatrics. May 2004;113(5):1451-1465.

Coco A, Vernacchio L, Horst M, Anderson A. Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline. Pediatrics. Feb 2010;125(2):214-220.

Forrest CB, Fiks AG, Bailey LC, et al. Improving adherence to otitis media guidelines with clinical decision support and physician feedback. Pediatrics. Apr 2013;131(4):e1071-1081.

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This measure examines all episodes per patient during the measurement period.

XML

Outpatient encounters of children, ages two months to 155 months (inclusive) on date of visit, who had a diagnosis of Acute Otitis Media (AOM) during the measurement period.

All patients aged 2 months through 12 years with a diagnosis of acute otitis media (AOM) and no antibiotic prescription in the prior 30 days

Diagnosis of alternate infection for which antibiotics are typically indicated will be excluded.

Patients who were prescribed amoxicillin

We excluded children under 2 months of age because of the likelihood of co-occurring diagnoses that are commonly associated with antimicrobial use.

None

For every patient evaluated by this measure, will also identify payer, race, ethnicity, and sex.