Utilization of services for otitis media by children enrolled in Medicaid

Objective: To provide population-based information about the utilization of ambulatory visits, antibiotic prescriptions, and surgical procedures related to the diagnosis and management of otitis media. Design: A descriptive study in which utilization rates per child and per child-year were calculated. Child-year rates stratified by age were calculated only for children having at least 1 ambulatory visit with a diagnosis of otitis media. Setting: Administrative data from Colorado Medicaid for the 1991 and 1992 calendar years. Patients: All children enrolled in Medicaid who are younger than 13 years and not participating in a prepaid health care plan during the study years (n = 131 169 and n = 157 065) were included in the analysis. Results: Approximately 22% of children made at least 1 ambulatory visit with a diagnosis of otitis media, with the peak prevalence (46.8%) occurring between ages 1 and 2 years. Among all children younger than 13 years enrolled in Medicaid, there were 0.5 ambulatory visits for otitis media per child (0.7 ambulatory visits per child-year), with 70% occurring in a physician office setting, 14.8% in a hospital clinic or community health center, and 15.2% in a hospital emergency department. For all children enrolled in Medicaid, the rate of antibiotic courses for otitis media was 0.34 per child (0.48/child-year). Each child with otitis media had an annual average of 1.55 antibiotic courses (1.82 antibiotic courses per child-year). The average ratio of antibiotic courses to ambulatory visits related to otitis media was 65%. There was an annual rate of 12 surgical procedures related to otitis media per 1000 children (16.6/1000child-years). The peak rate of ventilating tube insertion occurred in children ages 1 to 2 years and for adenoidectomy in children 3 to 6 years. Mastoidectomy rates were low, 92% occurring in children older than 2 years. Conclusions: This study represents preliminary techniques to profile the care of children with otitis media. Our findings support the need to measure volatility of enrollment in an insured population before calculating rates of utilization. Additional research is needed to measure the effects of discontinuous eligibility, access to a regular source of primary care, site of treatment, and physician preferences on the quantity and quality of treatments for otitis media.