Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008–2014

Tong, Sabine; Amand, Caroline; Kieffer, Alexia; Kyaw, Moe H.

doi:10.1186/s12913-018-3139-1

Cited by 89 publications

(68 citation statements)

References 23 publications

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“…Pediatricians overdiagnosed AOM in 27% of examinations, whereas otolaryngologists did 10% of the time . There are an estimated 19.5 million cases of AOM diagnosed per year in the United States, and AOM‐associated healthcare utilization and cost were found to have changed little between 2008 and 2014 . As a result, patients are treated unnecessarily with antibiotics and tympanostomy tubes, and millions of dollars are wasted.…”

Section: Discussionmentioning

confidence: 99%

“…6 There are an estimated 19.5 million cases of AOM diagnosed per year in the United States, and AOM-associated healthcare utilization and cost were found to have changed little between 2008 and 2014. 8 As a result, patients are treated unnecessarily with antibiotics and tympanostomy tubes, and millions of dollars are wasted. A lack of appropriate otoscopic training can continue to propagate the effects of misdiagnosis of this and other otologic pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 It is the most common condition for which antibacterial agents are prescribed for children, and the direct costs of management in the US population are $4.3 billion annually. 7,8 Accurate diagnosis of outer and middle ear diseases requires mastery of the otoscopic examination. 5 In the primary care settings, family medicine, internal medicine, pediatric, and emergency medicine practitioners are among those who need effective otoscopic diagnostic skills to treat patients appropriately.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy and confidence for otoscopy: Are medical students receiving sufficient training?

et al. 2018

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Objectives/Hypothesis To assess the confidence and abilities of medical students to diagnose specific types of otologic pathology, and to determine how different training experiences in medical school impact these outcomes. Study Design Survey analysis. Methods Sixty third‐ and fourth‐year medical students completed a computerized online survey. Participants answered questions about their otoscopic training experience and confidence, and provided diagnoses for 72 digital images taken with a high‐definition video otoscope that showed common otologic pathologies of the tympanic membrane and middle ear space. Results Most participants (65%) had received less exposure to otoscopic training in medical school than they expected. Confidence in diagnostic ability was low. For diagnostic ability, the mean percent correct across pathologies was 54% ± 7.7%. Medical school year (P = .006), intended specialty (P = .022), and total number of otolaryngology rotations (P = .048) were predictive of diagnostic accuracy on univariable logistic regression analyses, but medical school year (P = .039) was the only significant independent predictor in multivariable analysis. Intended specialty (P = .047) and total number of otolaryngology rotations (P = .035) were predictive of prequiz diagnostic confidence on univariable logistic regression analyses. Conclusions Medical students were not satisfied with their exposure to otoscopic training. Intended specialty, total number of otolaryngology rotations, and year in medical school predicted diagnostic accuracy. Intended specialty and total number of otolaryngology rotations predicted diagnostic confidence. Additional studies are needed to investigate how training experiences can be improved to optimize otoscopy training during medical school. Level of Evidence NA Laryngoscope, 129:1891–1897, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy and confidence for otoscopy: Are medical students receiving sufficient training?

et al. 2018

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“…Despite the introduction of the pneumococcal conjugate vaccine, 60% of children have experienced at least one episode of AOM by age 3 . Costs associated with AOM remain substantial, and parents often visit health care providers for pain and fever . Children less than 5 years have the highest incidence of AOM, and more than one‐third experience pain, fever, or both 3 to 7 days following treatment .…”

mentioning

confidence: 99%

“…Costs associated with AOM remain substantial, and parents often visit health care providers for pain and fever . Children less than 5 years have the highest incidence of AOM, and more than one‐third experience pain, fever, or both 3 to 7 days following treatment . Almost three‐quarters of parents report a significant impact on their work attendance and identify pain and disturbed sleep as the most important sources of AOM‐related burden .…”

mentioning

confidence: 99%

Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open‐label Trial

Belisle

Dobrin

Elsie

et al. 2019

Academic Emergency Medicine

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Background Thirty percent of children with acute otitis media (AOM) experience symptoms < 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions. Methods We randomized caregivers of children 6 months to 17 years presenting to the emergency department (ED) with AOM to discharge instructions using a video on management of pain and fever to a paper handout. The primary outcome was the AOM Severity of Symptom (AOM‐SOS) score at 72 hours postdischarge. Secondary outcomes included caregiver knowledge (10‐item survey), absenteeism, recidivism, and satisfaction (5‐item Likert scale). Results A total of 219 caregivers were randomized and 149 completed the 72‐hour follow‐up (72 paper and 77 video). The median (IQR) AOM‐SOS score for the video was significantly lower than paper, even after adjusting for preintervention AOM‐SOS score and medication at home (8 [7–11] vs. 10 [7–13], respectively; p = 0.004). There were no significant differences between video and paper in mean (±SD) knowledge score (9.2 [±1.3] vs. 8.8 [±1.8], respectively; p = 0.07), mean (±SD) number of children that returned to a health care provider (8/77 vs. 10/72, respectively; p = 0.49), mean (±SD) number of daycare/school days missed by child (1.2 [±1.5] vs. 1.1 [±2.1], respectively; p = 0.62), mean (±SD) number of workdays missed by caregiver (0.5 [±1] vs. 0.8 [±2], respectively; p = 0.05), or median (IQR) satisfaction score (5 [4–5] vs. 5 [4–5], respectively; p = 0.3). Conclusions Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout.

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Trends in Pediatric Primary Care Visits Among Commercially Insured US Children, 2008-2016

et al. 2020

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IMPORTANCE Primary care is the foundation of pediatric care. While policy interventions have focused on improving access and quality of primary care, trends in overall use of primary care among children have not been described.OBJECTIVE To assess trends in primary care visit rates and out-of-pocket costs, to examine variation in these trends by patient and visit characteristics, and to assess shifts to alternative care options (eg, retail clinics, urgent care, and telemedicine). DESIGN, SETTING, AND PARTICIPANTSObservational cohort study of claims data from 2008 to 2016 for children 17 years and younger covered by a large national commercial health plan. Visit rate per 100 child-years was determined for each year overall, by child and geographic characteristics, and by visit type (eg, primary diagnosis), and trends were assessed with a series of child-year Poisson models. Data were analyzed from November 2017 to September 2019. MAIN OUTCOMES AND MEASURESVisits to primary care and other settings.RESULTS This cohort study included more than 71 million pediatric primary care visits over 29 million pediatric child-years (51% male in 2008 and 2016; 37% between 12-17 years in 2008 and 38% between 12-17 years in 2016). Unadjusted results for primary care visit rates per 100 child-years decreased from 259.6 in 2008 to 227.2 in 2016, yielding a regression-estimated change in primary care visits across the 9 years of −14.4% (95% CI, −15.0% to −13.9%; absolute change: −32.4 visits per 100 child-years). After controlling for shifts in demographics, the relative decrease was −12.8% (95% CI, −13.3% to −12.2%). Preventive care visits per 100 child-years increased from 74.9 in 2008 to 83.2 visits in 2016 (9.9% change in visit rate; 95% CI, 9.0%-10.9%; absolute change: 8.3 visits per 100 child-years), while problem-based visits per 100 child-years decreased from 184.7 in 2008 to 144.1 in 2016 (−24.1%; 95% CI, −24.6% to −23.5%; absolute change: −40.6 visits per 100 child-years). Visit rates decreased for all diagnostic groups except for the behavioral and psychiatric category. Out-of-pocket costs for problem-based primary care visits increased by 42% during the same period. Per 100 child-years, visits to other acute care venues increased from 21.3 to 27.6 (30.3%; 95% CI, 28.5% to 32.1%; absolute change: 6.3 visits per 100 child-years) and visits to specialists from 45.2 to 53.5 (16.4%; 95% CI, 14.8% to 18.0%, absolute change: 8.3 visits per 100 child-years).CONCLUSIONS AND RELEVANCE Primary care visit rates among commercially insured children decreased over the last decade. Increases in out-of-pocket costs and shifts to other venues appear to explain some of this decrease.

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Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008–2014

Cited by 89 publications

References 23 publications

Diagnostic accuracy and confidence for otoscopy: Are medical students receiving sufficient training?

Diagnostic accuracy and confidence for otoscopy: Are medical students receiving sufficient training?

Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open‐label Trial

Trends in Pediatric Primary Care Visits Among Commercially Insured US Children, 2008-2016

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