Increasing Short-Course Treatment of Acute Otitis Media in a Pediatric Primary Care Network.

Abstract

This quality improvement effort aimed to increase the proportion of shorter-duration prescriptions for acute otitis media (AOM) in patients aged at least 2 years from a baseline of 30% to 50% without using an electronic health record (EHR) alert. The project was conducted in a large pediatric primary care network and used 2 plan-do-study-act cycles. Cycle 1 included updates to the electronic prescription orders of commonly used antibiotics to include shorter-duration "speed button" options. Cycle 2 combined education with clinician-specific performance feedback and clinical decision support in the form of a "preference list" of easily searchable, preconfigured electronic prescription orders with shorter durations. Weekly proportions of prescriptions for AOM with a duration of 7 days or fewer in children aged at least 2 years (primary measure) and a duration of fewer than 10 days in children aged less than 2 years (balancing measure) were analyzed. Interrupted time series models tested the association of interventions with observed changes in primary and balancing measures. The first intervention was ineffective at improving the primary measure. A combination of education, targeted feedback, and preconfigured prescription orders increased shorter-duration treatment courses for AOM by a factor of 2-fold to approximately 60% with an undesired small but statistically significant increase in the balancing measure (+1.8%). A combination of education with feedback and in-line clinical decision support in the form of easily searchable, preconfigured prescription orders (EHR "preference list") was successful in increasing shorter-duration prescriptions for AOM in a large primary care network without an EHR alert.