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Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis.

Publication ,  Journal Article
Sajisevi, M; Schulz, K; Cyr, DD; Wojdyla, D; Rosenfeld, RM; Tucci, D; Witsell, DL
Published in: Otolaryngol Head Neck Surg
January 2017

Objective To estimate the nonadherence rate of pressure equalization (tympanostomy) tube (PET) placement in the preceding 3-year period before release of the 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG). Study Design Analysis of the Truven Health MarketScan Research Databases (2010-2012). Subjects and Methods Medical claims data from 2010 to 2012 were analyzed. Children aged ≤12 years with otitis media (OM)-related diagnoses were identified. Adherence and nonadherence rates for OM and PET placement were analyzed through administrative codes extrapolated from the key action statements (KASs) of the CPG. KASs were aggregated to estimate the overall nonadherence and determine areas for quality improvement. Results A total of 9,726,411 visits with OM-associated codes among 3,710,730 children were identified: 2.9% (80,451 of 3,239,700) were considered nonadherent to KAS 1 because a code for PET placement occurred with a first episode of OM with effusion <3 months; 52.1% (14,534 of 27,913) underwent PET placement for OM with effusion of >3 months and had a concurrent hearing loss code. For those without hearing loss who underwent PET placement, 48.3% (52,921 of 109,583) had a diagnosis code indicating risk for speech, language, or learning problems. For each KAS, we found heterogeneity of computed nonadherence rates by region, age, and season. Conclusion Before guideline dissemination, we found low to moderate rates of nonadherence to guideline recommendation. Deeper analysis of mega-databases could provide better insights for measurement of guideline adherence. The expansion of administrative and clinical databases provides a unique opportunity to investigate the impact of CPGs.

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Published In

Otolaryngol Head Neck Surg

DOI

EISSN

1097-6817

Publication Date

January 2017

Volume

156

Issue

1

Start / End Page

87 / 95

Location

England

Related Subject Headings

  • Retrospective Studies
  • Practice Guidelines as Topic
  • Patient Selection
  • Otorhinolaryngology
  • Otitis Media
  • Middle Ear Ventilation
  • Male
  • Insurance Claim Review
  • Infant
  • Humans
 

Citation

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Sajisevi, M., Schulz, K., Cyr, D. D., Wojdyla, D., Rosenfeld, R. M., Tucci, D., & Witsell, D. L. (2017). Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis. Otolaryngol Head Neck Surg, 156(1), 87–95. https://doi.org/10.1177/0194599816669499
Sajisevi, Mirabelle, Kristine Schulz, Derek D. Cyr, Daniel Wojdyla, Richard M. Rosenfeld, Debara Tucci, and David L. Witsell. “Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis.Otolaryngol Head Neck Surg 156, no. 1 (January 2017): 87–95. https://doi.org/10.1177/0194599816669499.
Sajisevi M, Schulz K, Cyr DD, Wojdyla D, Rosenfeld RM, Tucci D, et al. Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis. Otolaryngol Head Neck Surg. 2017 Jan;156(1):87–95.
Sajisevi, Mirabelle, et al. “Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis.Otolaryngol Head Neck Surg, vol. 156, no. 1, Jan. 2017, pp. 87–95. Pubmed, doi:10.1177/0194599816669499.
Sajisevi M, Schulz K, Cyr DD, Wojdyla D, Rosenfeld RM, Tucci D, Witsell DL. Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis. Otolaryngol Head Neck Surg. 2017 Jan;156(1):87–95.
Journal cover image

Published In

Otolaryngol Head Neck Surg

DOI

EISSN

1097-6817

Publication Date

January 2017

Volume

156

Issue

1

Start / End Page

87 / 95

Location

England

Related Subject Headings

  • Retrospective Studies
  • Practice Guidelines as Topic
  • Patient Selection
  • Otorhinolaryngology
  • Otitis Media
  • Middle Ear Ventilation
  • Male
  • Insurance Claim Review
  • Infant
  • Humans