Hard to set OME standards due to lack of evidence
Hard to set OME standards due to lack of evidence
Clinical guidelines lead to child health measures
What is the best way to treat otitis media with effusion? The answer isn’t always clear, and that ambiguity has presented an obstacle to performance standards for treatment of this common ailment.
The American Academy of Pediatrics (AAP) in Elk Grove Village, IL, issued draft outcomes measures, but they include acceptable diagnosis and treatment alternatives. "It’s difficult to derive any kind of performance measure from a clinical option," acknowledges Carla T. Herrerias, MPH, program manager of the academy’s Division of Quality Care.
Complexity poses problems
She notes that the academy’s clinical practice guidelines on OME were based largely on a combination of scientific evidence and expert consensus. On many points, they lacked the quality of evidence that would lead to strong recommendations, she says.
Users of the draft outcomes measures can select the numerators and denominators they feel are most appropriate for a quality improvement project, she says. Physicians also can analyze variation in their practice patterns.
"I think they’re very good measures, and they’re scientifically sound," says Herrerias. "But they’re very complex at this point."
In a pilot test of the measures, another potential problem arose. There were variations in the interpretation of medical chart data between the two reviewers who were trained to abstract relevant information.
"The measures are complex and the instruction form was very complex," she says. "It points to a general concern for people who are trying to develop measures based on clinical chart reviews. When you base performance measures on substantial clinical chart reviews, you do encounter the potential problem of inter-rater reliability."
The AAP recently received a grant from the Agency for Health Care Policy and Research in Rockville, MD, to study implementation of another guideline-based set of measures on management of neonatal jaundice in healthy term newborns. "If we can implement a user-friendly format for measuring performance, we may be able to use that with [other measures]," Herrerias says.
The AAP has four published clinical practice guidelines and another nine in development. In addition to OME and neonatal jaundice, the academy has developed draft performance measures for acute gastroenteritis. These draft measures are unpublished to date.
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