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AAO12: Tympanostomy Tubes: Topical Ear Drop Monotherapy Acute Otorrhea

AAO12: Tympanostomy Tubes: Topical Ear Drop Monotherapy Acute Otorrhea

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High Priority: Yes; Appropriate Use
Percentage of patients age 6 months to 12 years of age at the time of the visit with a current diagnosis of an uncomplicated acute tympanostomy tube otorrhea (TTO) who were prescribed or recommended to use topical antibiotic eardrops and NOT prescribed systemic (IV or PO) antibiotics for acute tympanostomy tube otorrhea.

Denominator:
All patients age 6 months through 12 years of age at the time of the visit with a current diagnosis of an uncomplicated* acute** tympanostomy tube otorrhea.

* Uncomplicated refers to TTO that is not accompanied by high fever (38.5°C, 101.3°F), concurrent illness requiring systematic antibiotics (e.g., streptococcal pharyngitis, bacterial sinusitis), or cellulitis extending beyond the external ear canal to involve the pinna or adjacent skin.
** Acute refers to less than four weeks’ duration.

Denominator Exclusions:
None

Denominator Exceptions:
Medical reason for not prescribing/recommending topical antibiotic monotherapy or for prescribing oral antibiotics include:

• Patients with high fever;
• Patients with cellulitis of the ear or adjacent skin;
• Patients who are immunocompromised;
• Patients with oral antibiotic given for other concurrent condition including but not limited to streptococcal pharyngitis, bacterial sinusitis, pneumonia, pharyngitis, osteitis abscess, or other concurrent acute infection beyond the confines of the ear canal;
• Patients who failed topical antibiotic therapy;
• Patients with a cochlear implant;
• Patients with concurrent diabetes;
• Patients who were prescribed oral antibiotics by another clinician; concurrent diagnosis of acute suppurative otitis media effusion with intact eardrum; acute TTO persists, or worsens, despite topical antibiotic therapy.

Patient reason for not prescribing/recommending topical antibiotics or prescribing oral antibiotics include:

• Administration of eardrops is not possible because of local discomfort.
• Lack of tolerance.

Numerator:
Patients who were prescribed or recommended to use topical antibiotic eardrops and NOT prescribed systemic (IV or PO) antibiotics for acute tympanostomy tube otorrhea.

Measure Classifications:

  • Measure Type: Process
  • National Quality Strategy (NQS) domain: Effective Clinical Care
  • Meaningful Measure Area: Appropriate use of Healthcare
  • Calculation: 1st Performance Rate
    • Inverse measure: No
    • Continuous measure: No
    • Proportional measure: Yes
    • Ratio measure: No
    • Risk Adjusted measure: No
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