High Priority Status: Yes / Appropriate Use
NQF Number: N/A
Measure Description:
Percentage of patients aged 6 months to 12 years of age at the time of the visit with a current diagnosis of an uncomplicated acute tympanostomy tube otorrhea (TTO) who were prescribed or recommended to use topical antibiotic eardrops and NOT prescribed systemic (IV or PO) antibiotics for acute TTO
Instructions:
This measure is to be submitted a minimum of once per performance period for patients diagnosed with uncomplicated acute otorrhea after tympanostomy tube insertion. This measure may be submitted by clinicians based on the measure-specific denominator coding.
Denominator:
All patients aged 6 months through 12 years of age at the time of the visit with a current diagnosis of an uncomplicated* acute** TTO
* Uncomplicated refers to TTO that is not accompanied by high fever (38.5°C, 101.3°F), concurrent illness requiring systemic antibiotics (e.g., streptococcal pharyngitis, bacterial sinusitis), or cellulitis extending beyond the external ear canal to involve the pinna or adjacent skin
** Acute refers to less than four weeks’ duration
Denominator Note:
To meet the denominator criteria, a patient must have had tympanostomy tube insertion and an office visit for uncomplicated acute otorrhea within the performance period.
Denominator Exclusions:
None
Numerator:
Patients who were prescribed or recommended to use topical antibiotic eardrops and NOT prescribed systemic (IV or PO) antibiotics for acute TTO
Numerator Note:
To meet the intent of the measure, the numerator quality action must be performed at the encounter in which the active diagnosis of uncomplicated acute otorrhea is documented.
Definition:
• Prescribed – prescription given to the patient (guardian) for topical antibiotic eardrops at time of diagnosis.
• Not prescribed – prescription not provided to the patient (guardian) for systemic (IV or PO) antibiotics at time of diagnosis of otorrhea, or within 10 days of diagnosis if otorrhea is not resolved after use of topical antibiotic eardrops.
Denominator Exceptions:
Medical reason(s) for not prescribing/recommending topical antibiotic monotherapy or for prescribing oral antibiotics include:
• Patients with high fever;
• Patients with cellulitis of the ear or adjacent skin;
• Patients who are immunocompromised;
• Patients with oral antibiotic given for other concurrent condition including but not limited to streptococcal pharyngitis, bacterial sinusitis, pneumonia, pharyngitis, osteitis abscess, or other concurrent acute infection beyond the confines of the ear canal;
• Patients who failed topical antibiotic therapy;
• Patients with a cochlear implant;
• Patients with concurrent diabetes;
• Patients who were prescribed oral antibiotics by another clinician; concurrent diagnosis of acute suppurative otitis media with effusion with intact eardrum; acute TTO persists, or worsens, despite topical antibiotic therapy.
Patient reason(s) for not prescribing/recommending topical antibiotics or prescribing oral antibiotics include:
• Administration of eardrops is not possible because of local discomfort;
• Lack of tolerance
Measure Classifications:
Submission Pathway: Traditional MIPS
Measure Type: Process
National Quality Strategy (NQS) domain: Effective Clinical Care
Meaningful Measures Area: Appropriate Use of Healthcare
Care Setting(s): Ambulatory Care: Clinician Office/Clinic
Includes Telehealth: Yes
Number of Performance Rates: 1
Inverse measure: No
Continuous measure: No
Proportional measure: Yes
Ratio measure: No
Risk Adjusted measure: No
© 2023 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.
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The measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The measure and specifications are provided “as is” without warranty of any kind. Neither the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF), nor its members shall be responsible for any use of the measure. The AAO-HNSF and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.
