{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:35:28Z","timestamp":1792499728485,"version":"4.5.0"},"reference-count":65,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T00:00:00Z","timestamp":1495497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Cross\u2010sectional analysis of an administrative database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85\u20105.08; <jats:italic>P<\/jats:italic> &lt;. 001). After adjusting for age, sex, race\/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60\u20108.01; <jats:italic>P<\/jats:italic> =. 002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, <jats:italic>P<\/jats:italic> &lt;. 001) and less seen in a hospital\u2010based office or emergency department.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599817703046","type":"journal-article","created":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T14:57:26Z","timestamp":1495551446000},"page":"289-296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement"],"prefix":"10.1002","volume":"157","author":[{"given":"David E.","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek J.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Oregon Health and Science University Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M.","family":"Bellmunt","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Hospital Universitari de la Vall d\u2019Hebron Department of Surgery Universitat Aut\u00f2noma de Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology SUNY Downstate Medical Center New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison K.","family":"Ikeda","sequence":"additional","affiliation":[{"name":"School of Medicine Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J.","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815623467"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816683342"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2012.27.8.835"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.111.2.376"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215107007724"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199609000-00017"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2008.04.013"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2011.03.009"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2014.04.037"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489.2013.824113"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-015-0576-3"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215114002503"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.07.009"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.4168\/aair.2010.2.2.65"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.56"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta13370"},{"issue":"5","key":"e_1_2_10_18_1","first-page":"CD001935","article-title":"Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children","author":"Simpson SA","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2014.06.006"},{"key":"e_1_2_10_20_1","first-page":"79562","article-title":"Medicare program: hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs; organ procurement organization reporting and communication; transplant outcome measures and documentation requirements; electronic health record (EHR) incentive programs; payment to nonexcepted off\u2010campus provider\u2010based department of a hospital; hospital value\u2010based purchasing (VBP) program; establishment of payment rates under the Medicare physician fee schedule for nonexcepted items and services furnished by an off\u2010campus provider\u2010based department of a hospital. 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