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A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management

INTRODUCTION: Despite the American Academy of Pediatrics (AAP) guidelines for acute otitis media (AOM) describing a watchful waiting (WW) approach in qualifying patients, immediate antibiotics are consistently overutilized. The study team developed a multifaceted quality improvement intervention tha...

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Autores principales: Sun, Di, Rivas-Lopez, Vanessa, Liberman, Danica B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594788/
https://www.ncbi.nlm.nih.gov/pubmed/31579876
http://dx.doi.org/10.1097/pq9.0000000000000177
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author Sun, Di
Rivas-Lopez, Vanessa
Liberman, Danica B.
author_facet Sun, Di
Rivas-Lopez, Vanessa
Liberman, Danica B.
author_sort Sun, Di
collection PubMed
description INTRODUCTION: Despite the American Academy of Pediatrics (AAP) guidelines for acute otitis media (AOM) describing a watchful waiting (WW) approach in qualifying patients, immediate antibiotics are consistently overutilized. The study team developed a multifaceted quality improvement intervention that educated providers and families about WW and included a behavioral component to modify physician prescribing patterns. METHODS: We used data from a prior study of 250 patients 18 years old and younger with AOM in a tertiary care children’s hospital emergency department (ED) to characterize baseline AOM management before interventions. In this study, interventions took place from September to December 2016. Following the interventions, 65 patients were randomly selected, which would allow for the detection of a 20% increase in adherence to AAP guidelines for management of AOM. RESULTS: In the preintervention cohort of 250 patients, 247 had documented AOM. Two hundred thirty-one (93.5%) received immediate antibiotics, 7 (2.8%) underwent WW, and 9 (3.6%) were sent home without antibiotics. Overall management agreed with AAP guidelines at a rate of 44.1%. In the postintervention cohort of 65 patients, 63 met age and diagnostic criteria for AOM; 56 (88.9%) patients received immediate antibiotics; and 7 (11.1%) underwent WW. Postintervention, which the ED management of AOM agreed with AAP guidelines 60.3% of the time, was significantly increased from preintervention adherence (P = 0.02). CONCLUSIONS: A multipronged quality improvement intervention for AOM management in a single pediatric ED significantly improved adherence to AAP guidelines by increasing WW and reducing immediate antibiotic prescriptions.
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spelling pubmed-65947882019-10-02 A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management Sun, Di Rivas-Lopez, Vanessa Liberman, Danica B. Pediatr Qual Saf Individual QI projects from single institutions INTRODUCTION: Despite the American Academy of Pediatrics (AAP) guidelines for acute otitis media (AOM) describing a watchful waiting (WW) approach in qualifying patients, immediate antibiotics are consistently overutilized. The study team developed a multifaceted quality improvement intervention that educated providers and families about WW and included a behavioral component to modify physician prescribing patterns. METHODS: We used data from a prior study of 250 patients 18 years old and younger with AOM in a tertiary care children’s hospital emergency department (ED) to characterize baseline AOM management before interventions. In this study, interventions took place from September to December 2016. Following the interventions, 65 patients were randomly selected, which would allow for the detection of a 20% increase in adherence to AAP guidelines for management of AOM. RESULTS: In the preintervention cohort of 250 patients, 247 had documented AOM. Two hundred thirty-one (93.5%) received immediate antibiotics, 7 (2.8%) underwent WW, and 9 (3.6%) were sent home without antibiotics. Overall management agreed with AAP guidelines at a rate of 44.1%. In the postintervention cohort of 65 patients, 63 met age and diagnostic criteria for AOM; 56 (88.9%) patients received immediate antibiotics; and 7 (11.1%) underwent WW. Postintervention, which the ED management of AOM agreed with AAP guidelines 60.3% of the time, was significantly increased from preintervention adherence (P = 0.02). CONCLUSIONS: A multipronged quality improvement intervention for AOM management in a single pediatric ED significantly improved adherence to AAP guidelines by increasing WW and reducing immediate antibiotic prescriptions. Wolters Kluwer Health 2019-05-23 /pmc/articles/PMC6594788/ /pubmed/31579876 http://dx.doi.org/10.1097/pq9.0000000000000177 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Individual QI projects from single institutions
Sun, Di
Rivas-Lopez, Vanessa
Liberman, Danica B.
A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management
title A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management
title_full A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management
title_fullStr A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management
title_full_unstemmed A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management
title_short A Multifaceted Quality Improvement Intervention to Improve Watchful Waiting in Acute Otitis Media Management
title_sort multifaceted quality improvement intervention to improve watchful waiting in acute otitis media management
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594788/
https://www.ncbi.nlm.nih.gov/pubmed/31579876
http://dx.doi.org/10.1097/pq9.0000000000000177
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