Quality of care: a tracer diagnosis study of acute otitis media, comparing a district paediatric service with paediatric and otolaryngology emergency departments.

Acute otitis media was used as a tracer condition for comparing patient care as regards patient satisfaction, compliance and medical outcome in a district paediatric office, an otolaryngological and a paediatric hospital emergency department. The initial work-up of the 216 patients studied at the three units was in good agreement with predefined standards. However, while the district paediatrician arranged a follow-up for all patients, the hospitals did so only in 10--30% of the visits. Parent satisfaction was significantly higher at the district office when the time spent waiting and the time the patient was with the doctor were kept constant. Urinary penicillin was not detected in 1/17 of district paediatric and in 6/19 of otological patients. Compliance with follow-up was also much higher at the district paediatrician. Medical outcome did not differ between the units. The majority of the parents expressed preference for the type of care given in a neighbourhood service. It is suggested that the criteria for adequate treatment of acute otitis media adapted for emergency departments may be revised in case easy access is provided to a medical centre offering continuity of care and proper follow-up. Studies of the quality of care have so far not managed to demonstrate a definite and positive relationship between the process of care, patient satisfaction and final medical results.