Center for Health Care Quality, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Pediatrics. 2011 Jun;127(6):e1490-7. doi: 10.1542/peds.2009-3569. Epub 2011 May 23.
Current national efforts provide an opportunity to integrate performance measures into clinical practice and improve outcomes for children.
The goal of this study was to explore issues in developing and testing measures of care for children with otitis media with effusion (OME).
We assessed compliance with diagnostic, evaluation, and treatment measures for OME adapted from preliminary work of the Physician Consortium for Performance Improvement, using chart data in a convenience sample of practices from 2 primary care networks (Cincinnati Pediatric Research Group and the American Academy of Pediatrics Quality Improvement Innovation Network). Children aged 2 months to 12 years with at least 1 visit with a specified OME code during a 1-year period were included.
Of 23 practices, 4 could not locate eligible visits. Nineteen practices submitted 378 abstractions (range: 3-37 per practice) with 15 identifying <30 eligible visits. Performance on diagnosis (33%) and hearing evaluation (29%) measures was low but high on measures of appropriate medication use (97% decongestant/antihistamine, 87% antibiotics, and 95% corticosteroids). Thirty-five percent of records documented antibiotic use concurrent with OME; only 16% of the 94 cases that cited reason for prescribing were appropriate. Using methods that consider appropriate clinical action, a more accurate rate for appropriate use of antibiotics was 68%.
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.
当前的国家努力为将绩效措施融入临床实践并改善儿童的治疗结果提供了机会。
本研究旨在探讨开发和测试儿童分泌性中耳炎（OME）护理措施时所面临的问题。
我们评估了从 Physician Consortium for Performance Improvement 的初步工作中改编的用于 OME 的诊断、评估和治疗措施的遵守情况，使用来自 2 个初级保健网络（辛辛那提儿科研究小组和美国儿科学会质量改进创新网络）的实践中的图表数据。纳入了在 1 年内至少有 1 次符合特定 OME 编码的就诊的 2 个月至 12 岁的儿童。
在 23 个实践中，有 4 个无法找到符合条件的就诊记录。19 个实践提交了 378 份摘要（范围：每个实践 3-37 份），其中有 15 份仅确定了<30 次符合条件的就诊。诊断（33%）和听力评估（29%）措施的执行率较低，但适当药物使用（97%的减充血剂/抗组胺药、87%的抗生素和 95%的皮质激素）的措施执行率较高。35%的记录记录了在 OME 期间同时使用抗生素，而只有 16%的 94 个引用了处方理由的病例是合适的。使用考虑到适当临床行动的方法，抗生素使用的适当率为 68%。
编码、病例发现和评估治疗的适当性是评估 OME 儿童护理时需要考虑的一些问题。本研究强调了在“真实世界”环境中测试拟议的护理质量措施的重要性。
