TABLE 1

Adherence to OM Guidelines Metric Definitions for Children 2 Months to 12 Years of Age

Metric name: Guideline RecommendationAdherence to Guideline Metric Definition
DenominatorNumerator
All OM
 Pain assessed: Pain should be assessed for all patients with OM.• OM visit• Pain score recorded
 Pain treated: Moderate to severe pain should be treated with analgesics for all patients with OM.• OM visit• Analgesic prescribed or analgesic recommended in the patient instructions
• Pain score ≥4
AOM
 AOM adequate diagnostic evaluation: Clinicians should identify signs of a middle-ear effusion and evaluate for signs and symptoms of middle-ear inflammation.• AOM visit• Effusion or poor tympanic membrane movement documented
• Middle ear inflammation documented—defined as tympanic membrane inflammation recorded in examination, pain documented in progress note, or nonzero pain score
 Amoxicillin as first-line therapy for AOM: Amoxicillin is the treatment of first choice for AOM.• AOM visit• Amoxicillin prescribed
• First visit in AOM episode
• Oral antibiotic prescribed
• No co-occurring pneumonia, sinusitis, conjunctivitis, or pharyngitis
• No allergy to penicillin
 AOM treatment of penicillin-allergic patients: Appropriate antibiotics should be prescribed for penicillin-allergic patients treated for AOM.• AOM visit• If type I allergy, oral macrolide prescribed and oral cephalosporin not prescribed or if non–type I allergy, either an oral cephalosporin or macrolide prescribed
• First visit in AOM episode
• Oral antibiotic prescribed
• No co-occurring pneumonia, sinusitis, conjunctivitis, or pharyngitis
• Either type I (hives/urticaria or anaphylaxis) or non–type I penicillin allergy
 High-dose amoxicillin for AOM: When amoxicillin is used for AOM, a high dosage should be prescribed (80–90 mg/kg per day).• AOM visit• Patient wt recorded on day of visit
• First visit in AOM episode• If patient wt <25 kg, amoxicillin dose is ≥60 mg/kg/day or if patient wt ≥25 kg, amoxicillin dose is ≥1500 mg/day
• Oral antibiotic prescribed
• No co-occurring pneumonia, sinusitis, conjunctivitis, or pharyngitis
• Amoxicillin prescribed at visit
 AOM watchful waiting: Watchful waiting can be done in a child with uncomplicated AOM.• AOM visit• Oral antibiotic not prescribed
• First visit in AOM episode
• No co-occurring pneumonia, sinusitis, conjunctivitis, or pharyngitis
• Age 6–24 mo: not severe illness (temperature <39°C and pain score 0–3) and uncertain diagnosis (criteria for adequate documentation not met)
• Age ≥25 mo to 12 y: not severe illness (temperature <39°C and pain score 0-3) or uncertain diagnosis (criteria for adequate documentation not met)
OME
 OME adequate diagnostic evaluation: Clinicians should document OME with pneumatic otoscopy or tympanometry and record laterality of effusion.• OME visit• Laterality of effusion documented
• Diagnostic testing for effusion done
 Avoidance of decongestants and antihistamines for OME: Decongestants or antihistamines should not be used because they are ineffective in the treatment of OME.• OME visit• No decongestant or antihistamine or cough/cold preparation prescribed
• OME is only diagnosis
 OME watchful waiting: Clinicians should manage OME with watchful waiting.• OME visit• No oral antibiotic prescribed
• First visit in the episode
• No co-occurring pneumonia, sinusitis, conjunctivitis, or pharyngitis