146 - The Otitis Media Treatment Index—A Proposed Metric for Antimicrobial Stewardship in Pediatric Otitis Media Care

Publication Number: 146.6771

Louis Vernacchio, Pediatric Physicians' Organization at Boston Children's, Wellesley, MA, United States; Laura B. Patane, Boston Childrens' Hospital, Cambridge, MA, United States; Naveed Rabbani, Pediatric Physicians' Organization at Children's, Wellesley, MA, United States; Hatoun Jonathan, Boston Children's Hospital, Wellesley, MA, United States

Background: Otitis media (OM) is the most common reason for antibiotic prescriptions for U.S. children and data indicate that this condition is frequently overdiagnosed and overtreated, contributing to unnecessary antibiotic use and antimicrobial resistance. Yet, to date no widely accepted metrics exist to compare OM diagnosis and treatment patterns among sites or individual clinicians.

Objective: To develop a readily understandable and reliable metric that quantifies a clinician’s propensity to diagnose OM and treat with antibiotics, which can be used in OM-focused quality improvement and antibiotic stewardship programs.

Design/Methods: We developed and validated a new clinical performance metric called the Otitis Media Treatment Index (OMTI) which calculates the proportion of all visits with an OM diagnosis (ICD-10 H65x and H66x) and a systemic antibiotic prescribed out of all visits with a respiratory illness diagnosis for children 6-59 months of age. We developed the OMTI using electronic health record data from the Pediatric Physicians’ Organization at Children’s, a pediatric primary care network of 80 private practices throughout Massachusetts. We calculated the OMTI using data from calendar year 2022 and validated it with data from 2023. We included data from 378 clinicians who had at least 100 encounters with a respiratory illness diagnosis in each of the two years studied.

Results: For 2022, there were 82,331 encounters with a respiratory diagnosis with 30,058 having an OM diagnosis and a systemic antibiotic prescribed, yielding a network-wide OMTI of 36.5%. OMTI ranged from 4.2% to 85.0% (interquartile range: 25.9-47.9%) for individual clinicians (Figure 1). For 2023, the overall OMTI was 29,327/80,756 (36.3%) with individual clinicians ranging from 4.9% to 74.6% (Interquartile range: 26.2-45.1%). OMTI showed moderately high correlation between 2022 and 2023 for individual clinicians (R2=0.70; Figure 2). OMTI was fairly stable across patient characteristics including age, sex, and insurance type (Figure 3) suggesting that adjustment for such factors is not needed to reasonably compare clinicians or sites.

Conclusion(s): The OMTI captures variability in OM diagnosis and antibiotic prescribing among pediatric clinicians and is fairly stable across patient sex, age (from 6 months to 5 years), and insurance type. This metric could be used to compare judiciousness of OM diagnosis and treatment across clinical sites or individual clinicians and could serve as a useful metric for OM-focused quality improvement and antibiotic stewardship projects.

Figure 1
Figure 1.pdfOtitis Media Treatment Index variability by individual clinician. Each grey dot represents one clinician.

Figure 2
Figure 2.pdfOtitis Media Treatment Index correlation between 2022 and 2023 for individual clinicians. Each grey dot represents one clinician.

Figure 3
Figure 3.pdfVariability in the Otitis Media Treatment Index by key patient demographics.