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Introducing a Multifaceted Intervention to Improve the Management of Otitis Media: How Do Pediatricians, Internists, and Family Physicians Respond?

University of Rochester School of Medicine and Dentistry, Rochester, New York.

Howard Beckman, MD

University of Rochester School of Medicine and Dentistry, Rochester, New York; Rochester Individual Practitioner Association, 3540 Winton Place, Rochester, NY 14623 hbeckman{at}ripa.org

John Chamberlain, MD

University of Rochester School of Medicine and Dentistry, Rochester, New York; Rochester Individual Practice Association, Rochester, New York.

Greg Partridge, BA

Robert A. Greene, MD

Rochester Individual Practice Association, Rochester, New York.

The objective of this studywas tocomparepediatricians, family practitioners, and internist's adherence rates to an individual practice association-developed otitis media practice guideline. The study included a cohort of primary care physicians treating acute otitis media between January 1, 1999, and December 31, 2001, using administrative data. All panel pediatricians, family practitioners, and internists were included in the analysis. Specialty otitis media guideline adherence rates were compared preand postintervention. The guideline was adapted from the 1999 Centers for Disease Control and Prevention's treatment recommendations. The outcome measure was overall and specific exceptions to practice guideline components prior to and after intervention per 1000 episodes. Pediatricians and internists significantly reduced overall exceptions per 1000 episodes (P< .000) from the preto postintervention periods. Family practitioners did not improve adherence to overall guideline recommendations postintervention (P> .05). Pediatricians had significantly higher compliance than did family practitioners (P< .000). Primary care physicians significantly increased adherence to an otitis media guideline. Pediatricians improved more than internists and significantly more than family physicians.

Key Words: physician incentive plans • physician practice patterns • health services research • otitis media • guideline adherence • acute disease • quality of health care

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