Table 2.
Association of Clinical Decision Support Use with Otitis Media Guideline Adherence
| Guideline Adherence Metric* (n = Number of Visits) | CDS Use | No CDS Use | Adjusted Percentage Difference in Guideline Adherence (CDS Use – No CDS Use) (p-value)† |
|---|---|---|---|
| 6,752 visits (%) | 34,639 visits (%) | ||
| Comprehensive measures‡ | |||
| Comprehensive AOM care | |||
| Achieved (n = 2,888) | 851 (20.0) | 2,037 (10.9) | 7.5 (<.001) |
| Not achieved (n = 19,983) | 3,400 (80.0) | 16,583 (89.1) | |
| Comprehensive OME care | |||
| Achieved (n = 180) | 54 (14.0) | 126 (3.7) | 8.6 (.01) |
| Not achieved (n = 3,611) | 332 (86.0) | 3,279 (96.3) | |
| All otitis media (OM) | |||
| OM: Pain assessed | |||
| Done (n = 39,868) | 6,498 (96.2) | 33,370 (96.3) | −1.2 (.45) |
| Not done (n = 1,523) | 254 (3.8) | 1,269 (3.7) | |
| OM: Pain treated | |||
| Done (n = 2,730) | 983 (82.0) | 1,747 (32.5) | 48.2 (<.001) |
| Not done (n = 3,849) | 216 (18.0) | 3,633 (67.5) | |
| Acute otitis media (AOM) | |||
| AOM: Adequate diagnostic evaluation | |||
| Done (n = 12,969) | 2,559 (53.2) | 10,410 (45.3) | 7.5 (.2) |
| Not done (n = 14,838) | 2,255 (46.8) | 12,583 (54.7) | |
| AOM: Amoxicillin used as first-line therapy | |||
| Done (n = 15,191) | 3,170 (84.9) | 12,021 (76.6) | 5.4 (.007) |
| Not done (n = 4,228) | 563 (15.1) | 3,665 (23.4) | |
| AOM: Appropriate antibiotic for penicillin-allergic patients | |||
| Done (n = 1,131) | 223 (81.1) | 908 (76.9) | 4.9 (.04) |
| Not done (n = 324) | 52 (18.9) | 272 (23.1) | |
| AOM: High-dose Amoxicillin prescribed | |||
| Done (n = 9,608) | 2,484 (77.9) | 7,124 (58.9) | 16.8 (.02) |
| Not done (n = 5,678) | 705 (22.1) | 4,973 (41.1) | |
| AOM: Antibiotics appropriately not prescribed | |||
| Done (n = 937) | 117 (4.2) | 820 (6.6) | −2.7 (<.001) |
| Not done (n = 14,379) | 2,698 (95.8) | 11,681 (93.4) | |
| Otitis media with effusion (OME) | |||
| OME: Adequate diagnostic evaluation | |||
| Done (n = 613) | 198 (19.1) | 415 (5.5) | 12.0 (.01) |
| Not done (n = 7,917) | 836 (80.9) | 7,081 (94.5) | |
| OME: Antibiotics not prescribed | |||
| Done (n = 2,818) | 263 (88.6) | 2,555 (87.1) | 1.4 (.6) |
| Not done (n = 411) | 34 (11.4) | 377 (12.9) | |
Note: These results describe the difference in achievement (yes/no) of each quality metric between visits where the CDS was used versus visits where the CDS was not used. All clinicians had access to the CDS. Bold text indicates p < .05.
Guideline adherence metrics were defined based on national guidelines, with input from a local advisory panel.
A marginal model with a logit link function and robust standard error estimates accounting for clustering in practices was used. Model included tool use (yes/no) and controlled for patient, clinician, and visit-level covariates.
Comprehensive care refers to visits eligible for at least three individual quality metrics with all of them achieved.