Month: February 2008

Trends in Acute Otitis Media-Related Health Care Utilization — Pediatrics

This study suggests that that things are getting better!

Trends in Acute Otitis Media-Related Health Care Utilization by Privately Insured Young Children in the United States, 1997?2004Fangjun Zhou, PhDa, Abigail Shefer, MDa, Yuan Kong, MSb and J. Pekka Nuorti, MD, DScaa National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgiab Science Applications International, San Diego, California

OBJECTIVE. The goal was to estimate the population effect of 7-valent pneumococcal conjugate vaccine on rates of acute otitis media-related ambulatory visits and antibiotic prescriptions for <2-year-old children enrolled in private insurance plans.METHODS. We performed a retrospective analysis of a defined population by using the 1997?2004 MarketScan databases, which included an average of >500000 person-years of observations for children <2 years of age. Trends in rates of International Classification of Diseases, Ninth Revision-coded ambulatory visits and antibiotic prescriptions attributable to acute otitis media were evaluated, and the national direct medical expenditures for these outcomes were estimated.RESULTS. In a comparison of 2004 with 1997?1999 (baseline period), rates of ambulatory visits and antibiotic prescriptions attributable to acute otitis media decreased from 2173 to 1244 visits per 1000 person-years (42.7% reduction) and from 1244 to 722 prescriptions per 1000 person-years (41.9% reduction), respectively. Total, estimated, national direct medical expenditures for acute otitis media-related ambulatory visits and antibiotic prescriptions for children <2 years of age decreased from an average of $1.41 billion during 1997 to 1999 to $0.95 billion in 2004 (32.3% reduction).CONCLUSIONS. Acute otitis media-related health care utilization and associated antibiotic prescriptions for privately insured young children decreased more than expected (on the basis of efficacy estimates in prelicensure clinical trials) after the introduction of routine 7-valent pneumococcal conjugate vaccine immunization. Although other factors, such as clinical practice guidelines to reduce antibiotic use, might have contributed to the observed trend, 7-valent pneumococcal conjugate vaccine may play an important role in reducing the burden of acute otitis media, resulting in substantial savings in medical care costs.

Trends in Acute Otitis Media-Related Health Care Utilization by Privately Insured Young Children in the United States, 1997-2004 — Zhou et al. 121 (2): 253 — Pediatrics

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Mark is still dead

Last week I wrote about Mark. 

Unfortunately – the bad dream that he had died wasn't a dream – and it's been a surreal week – re-connecting with old friends, and re-living formative memories.

Mark was a passionate, thoughtful person who worked so hard to make things RIGHT ? while doing his best to have fun – with a unique serene yet sardonic demeanor.

In 1982, I was Mark?s apprentice for 12 months on the 144? sailing ship ? the Barkentine r/v Regina Maris ? where he was Chief Engineer (El Jefe) ? and I was the Assistant Engineer (El Lacayo) – earning $1 / day.

It?s Mark?s fault that I am a physician.

As we diagnosed, disassembled (and reassembled) diesel engines, bilge pumps, de-salinators and generators together ? Mark taught me the fine art of diagnosis, decision making, and careful, patient action. 

In healthcare we call this SOAP (Subjective Objective Assessment and Plan) ? On Six Forks Road (and Toyota) ? it?s called PDCA (Plan-do-check-adjust).

Medical Educators call it GNOME.

Regardless of the name/ framework/ religion we use ? it?s about thinking carefully, calmly and strategically about where you want to end up ? then having the knowledge, skill and attitude to get you there.

We're on our way to Mark's memorial service now.  Marcie sent me this last night – which does a better job than I ever will in telling a short story about our friend: