Otitis Media with Effusion: Systemic Antimicrobials - Avoidance of

Measure Specification

OME usually resolves spontaneously with indications for therapy only if the condition is persistent and clinically significant benefits can be achieved. Systemic antimicrobials have no proven long-term effectiveness and have potential adverse effects. The purpose of the corresponding guideline statement is to reduce ineffective and potentially harmful medical interventions in OME when there is no long-term benefit to be gained in the vast majority of cases.

Medications have long been used to treat OME, with the dual goals of improving quality of life (QOL) and avoiding more invasive surgical interventions. Both the 1994 guidelines and the 2004 guidelines determined that the weight of evidence did not support the routine use of steroids (either oral or intranasal), antimicrobials, antihistamines, or decongestants as therapy for OME.

Clinicians should recommend against using systemic antibiotics for treating OME. Strong recommendation based on systematic review of randomized clinical trials (RCTs) and preponderance of harm over benefit [1]. Data detailing the prescription of systemic antimicrobials for OME in children is limited. However, in a small 2008 study by Patel et al., 7% of physicians in an otolaryngology practice prescribed systemic antimicrobials for pediatric patients presenting with OME [2].

In a 2014 study involving 5 focus groups of parents, most parents believed that antibiotics were needed to treat otitis media and expressed frustration with a “watchful waiting” approach [3]. In a 2013 study by Forrest et al. evaluating clinical decision support for management of OME, 78%-93% of physicians employed a “watchful waiting” strategy to manage OME [4].

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, each unique occurrence starts with the onset of OME symptoms and concludes with the resolution of OME or after 90 days if a resolution of OME symptoms is not documented. A new occurrence of OME cannot start until the previous occurrence during the performance period has concluded.

If multiple denominator eligible encounters are documented within an identified occurrence, Merit-based Incentive Payment System (MIPS) eligible clinicians should submit the most recent encounter associated within that occurrence.