Effectiveness of Centers for Disease Control and Prevention recommendations for outcomes of acute otitis media.
OBJECTIVE
To determine whether we could increase adherence to the Centers for Disease Control and Prevention (CDC) recommendations with well-accepted approaches to improving quality of care and adherence to the CDC recommendations resulted in improved outcomes for acute otitis media (AOM).


METHODS
A cluster randomization study was conducted in 12 pediatric practices (6 intervention and 6 control sites). The main outcome measures were adherence to the CDC recommendations (modified to include 2 additional antimicrobial agents) and a subsequent antibiotic prescription for AOM within 30 days after diagnosis.


RESULTS
Of 3152 patients referred to research assistants, 2584 (82%) were eligible. Of those eligible, 1368 (99%) of 1382 at the intervention sites and 1138 (99%) of 1146 at the control sites consented to participate. Rates of adherence to the CDC recommendations were not significantly higher at the intervention sites than at the control sites, for initial enrollment episodes (78.2% vs 70.6%) or second episodes (62.6% vs 59.9%). After controlling for clustering according to site and covariates, children who were not treated in adherence to the CDC recommendations for both episodes had 1.60 times the odds of a subsequent prescription within 12 days, compared with those treated in adherence at both episodes.


CONCLUSIONS
Despite using evidence-based approaches that are known to influence physician behavior, we were unable to increase adherence to the CDC recommendations for treatment of AOM. However, we did establish that prescription of antimicrobial therapy consistent with the CDC recommendations for a second episode of AOM was associated with improved outcomes, measured as the need for subsequent antibiotic prescription. Because of the selection of resistant otopathogens, adherence to the CDC recommendations is likely more important in subsequent episodes of AOM than in the initial episode.
Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA. howard.bauchner@bmc.org
Howard
H
Bauchner
Colin D
CD
Marchant
Alice
A
Bisbee
Timothy
T
Heeren
Bingxia
B
Wang
Megan
M
McCabe
Stephen
S
Pelton
D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002656:Child Day Care Centers; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000188:drug therapy* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
D000890:Anti-Infective Agents