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Article ; Online: Patient Characteristics and Telemedicine Use in the US, 2022.

Chang, Eva / Penfold, Robert B / Berkman, Nancy D

JAMA network open

2024 Volume 7, Issue 3, Page(s) e243354

Abstract: Importance: Telemedicine use was common during the COVID-19 pandemic, expanding many patients' approaches to accessing health care. Of concern is whether telemedicine access was poorer among higher-needs and disadvantaged populations.: Objective: To ... ...

Abstract	Importance: Telemedicine use was common during the COVID-19 pandemic, expanding many patients' approaches to accessing health care. Of concern is whether telemedicine access was poorer among higher-needs and disadvantaged populations. Objective: To assess patient characteristics associated with telemedicine use and telemedicine mode and describe telemedicine visit experiences by telemedicine mode. Design, setting, and participants: This cross-sectional study included data from the 2022 Health Information National Trends Survey and included US adults with a health care visit. Data were analyzed from May to September 2023. Exposure: Patient characteristics. Main outcomes and measures: Any telemedicine visits vs in-person visits only; telemedicine mode (video vs audio-only). Multivariable logistic models assessed patient characteristics associated with telemedicine visits and mode. Bivariate analyses compared telemedicine experiences by mode. Results: The study included 5437 adult patients (mean [SE] age, 49.4 [0.23] years; 3136 females [53.4%]; 1928 males [46.6%]). In 2022, 2384 patients (43%) had a telemedicine visit; 1565 (70%) had a video visit while 819 (30%) had an audio-only visit. In multivariable models, older age (≥75 years: adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.94), no internet use (aOR, 0.62; 95% CI, 0.48-0.81), and living in the Midwest (aOR, 0.50; 95% CI, 0.35-0.70) were negatively associated with having telemedicine visits. Female sex (aOR, 1.43; 95% CI, 1.12-1.83), having chronic conditions (aOR, 2.13; 95% CI, 1.66-2.73), and multiple health care visits (2-4 visits: aOR, 1.77; 95% CI, 1.23-2.54; ≥5 visits: aOR, 3.29; 95% CI, 2.20-4.92) were positively associated. Among individuals who used telemedicine, older age (65-74 years: aOR, 2.13; 95% CI, 1.09-4.14; ≥75 years: aOR, 3.58; 95% CI, 1.60-8.00), no health insurance (aOR, 2.84; 95% CI, 1.42-5.67), and no internet use (aOR, 2.11; 95% CI, 1.18-3.78) were positively associated with having audio-only visits. We observed no significant differences in telemedicine use or mode by education, race and ethnicity, or income. Patients' experiences using telemedicine were generally similar for video and audio-only except more individuals who used audio-only had privacy concerns (20% vs 12%, P = .02). Conclusions and relevance: In this cross-sectional study of adults with health care visits, many patients, including those with the greatest care needs, chose telemedicine even after in-person visits were available. These findings support continuing this care delivery approach as an option valued by patients. Differences were not observed by most common measures of socioeconomic status. Continued monitoring of telemedicine use is needed to ensure equitable access to health care innovations.
MeSH term(s)	Adult ; Male ; Humans ; Female ; Middle Aged ; Cross-Sectional Studies ; Pandemics ; Telemedicine ; COVID-19/epidemiology ; Correlation of Data
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.3354
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic.

Chang, Eva / Davis, Teaniese L / Berkman, Nancy D

Medical care

2023

Abstract: Background: Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 ... ...

Abstract	Background: Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 pandemic. Objective: To assess the impact of English proficiency on delayed and forgone health care during the early COVID-19 pandemic. Research design: Multivariate logistic regression analysis of National Health Interview Survey data (July-December 2020; n=16,941). Outcomes were self-reported delayed and forgone health care because of cost or the COVID-19 pandemic. Delayed health care included medical, dental, mental health, and pharmacy care. Forgone health care also included care at home from a health professional. Results: A greater percentage of LEP adults reported delayed (49%) and forgone (41%) health care than English-proficient adults (40% and 30%, respectively). However, English proficiency was not significantly associated with delayed or forgone health care, after adjusting for demographic, socioeconomic, and health factors. Among LEP adults, multivariate models showed that being uninsured, having a disability, and having chronic conditions increased the risk of delaying and forgoing health care. LEP adults of Asian race and Hispanic ethnicity were also more likely to forgo health care while those with 65+ years were less likely to forgo health care. Conclusions: Adults with LEP were more likely to experience challenges accessing health care early in the pandemic. Delayed and forgone health care were explained by low socioeconomic status and poor health. These findings highlight how during a period of limited health resources, deficiencies in the health care system resulted in an already disadvantaged group being at greater risk of inequitable access to care.
Language	English
Publishing date	2023-12-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	411646-x
ISSN	1537-1948 ; 0025-7079
ISSN (online)	1537-1948
ISSN	0025-7079
DOI	10.1097/MLR.0000000000001963
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Article ; Online: Differences in Telemedicine, Emergency Department, and Hospital Utilization Among Nonelderly Adults with Limited English Proficiency Post-COVID-19 Pandemic: a Cross-Sectional Analysis.

Chang, Eva / Davis, Teaniese L / Berkman, Nancy D

Journal of general internal medicine

2023 Volume 38, Issue 16, Page(s) 3490–3498

Abstract: Background: The unprecedented use of telemedicine during the COVID-19 pandemic provided an opportunity to examine its uptake among individuals with limited English proficiency (LEP).: Objective: To assess telemedicine use among nonelderly adults with ...

Abstract	Background: The unprecedented use of telemedicine during the COVID-19 pandemic provided an opportunity to examine its uptake among individuals with limited English proficiency (LEP). Objective: To assess telemedicine use among nonelderly adults with LEP and the association between use of telehealth and emergency department (ED) and hospital visits. Design: Cross-sectional study using the National Health Interview Survey (July 2020-December 2021) PARTICIPANTS: Adults (18-64 years), with LEP (N=1488) or English proficiency (EP) (N=25,873) MAIN MEASURES: Telemedicine, ED visits, and hospital visits in the past 12 months. We used multivariate logistic regression to assess (1) the association of English proficiency on having telemedicine visits; and (2) the association of English proficiency and telemedicine visits on having ED and hospital visits. Key results: Between July 2020 and December 2021, 22% of adults with LEP had a telemedicine visit compared to 35% of adults with EP. After controlling for predisposing, enabling, and need factors, adults with LEP had 20% lower odds of having a telemedicine visit than adults with EP (p=0.02). While English proficiency was not associated with ED or hospital visits during this time, adults with telemedicine visits had significantly greater odds of having any ED (aOR: 1.80, p<0.001) and hospital visits (aOR: 2.03, p<0.001) in the past 12 months. Conclusions: While telemedicine use increased overall during the COVID-19 pandemic, its use remained much less likely among adults with LEP. Interventions targeting structural barriers are needed to address disparities in access to telemedicine. More research is needed to understand the relationship between English proficiency, telemedicine visits, and downstream ED and hospital visits.
MeSH term(s)	Adult ; Humans ; Limited English Proficiency ; Cross-Sectional Studies ; Language ; Pandemics ; Communication Barriers ; COVID-19/epidemiology ; Emergency Service, Hospital ; Hospitals ; Telemedicine
Language	English
Publishing date	2023-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-023-08353-7
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Article ; Online: Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review.

Chang, Eva / Ali, Rania / Berkman, Nancy D

BMJ open

2022 Volume 12, Issue 6, Page(s) e058539

Abstract: Objective: Payers, providers and policymakers in the USA are interested in developing interventions that reduce preventable or modifiable healthcare use among high-need, high-cost (HNHC) patients. This study seeks to describe how and why complex ... ...

Abstract	Objective: Payers, providers and policymakers in the USA are interested in developing interventions that reduce preventable or modifiable healthcare use among high-need, high-cost (HNHC) patients. This study seeks to describe how and why complex interventions for HNHC patients lead to more appropriate use of healthcare services. Design: A realist review which develops programme theories from causal explanations generated and articulated through the creation of context-mechanism-outcome configurations. Methods: Electronic databases (including PubMed and Embase) and gray literature from January 2000 to March 2021 were searched. All study designs were included if the article provided data to develop our programme theories. Included studies were conducted in the USA and focused on interventions for adult, HNHC patients. Results: Data were synthesised from 48 studies. Identifying HNHC patients for inclusion in interventions requires capturing a combination of characteristics including their prior use of healthcare services, complexity of chronic disease(s) profile, clinician judgment and willingness to participate. Once enrolled, engaging HNHC patients in interventions requires intervention care providers and patients to build a trusting relationship. Tailored, individualised assistance for medical and non-medical needs, emotional support and self-management education empowers patients to increase their participation in managing their own care. Engagement of care providers in interventions to expand support of HNHC patients is facilitated by targeted outreach, adequate staffing support with shared values and regular and open communication. Conclusions: Building relationships with HNHC patients and gaining their trust is a key component for interventions to successfully change HNHC patients' behaviors. Identifying HNHC patients for an intervention can be best achieved through a multipronged strategy that accounts for their clinical and psychosocial complexity and prior experiences with the healthcare system. Successful interventions recognise that relationships with HNHC patients require the sustained engagement of care providers. To succeed, providers need ongoing emotional, financial, logistical and practical resources. Prospero registration number: CRD42020161179.
MeSH term(s)	Adult ; Communication ; Delivery of Health Care ; Humans ; Surveys and Questionnaires
Language	English
Publishing date	2022-06-09
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-058539
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Article ; Online: Unpacking complex interventions that manage care for high-need, high-cost patients

Eva Chang / Rania Ali / Nancy D Berkman

BMJ Open, Vol 12, Iss

a realist review

2022 Volume 6

Keywords	Medicine ; R
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characteristics of High-Need, High-Cost Patients : A "Best-Fit" Framework Synthesis.

Berkman, Nancy D / Chang, Eva / Seibert, Julie / Ali, Rania

Annals of internal medicine

2022

Abstract: Background: Accurately identifying high-need, high-cost (HNHC) patients to reduce their preventable or modifiable health care use for their chronic conditions is a priority and a challenge for U.S. policymakers, health care delivery systems, and payers.! ...

Abstract	Background: Accurately identifying high-need, high-cost (HNHC) patients to reduce their preventable or modifiable health care use for their chronic conditions is a priority and a challenge for U.S. policymakers, health care delivery systems, and payers. Purpose: To identify characteristics and criteria to distinguish HNHC patients. Data sources: Searches of multiple databases and gray literature from 1 January 2000 to 22 January 2022. Study selection: English-language studies of characteristics and criteria to identify HNHC adult patients, defined as those with high use (emergency department, inpatient, or total services) or high cost. Data extraction: Independent, dual-review extraction and quality assessment. Data synthesis: The review included 64 studies comprising multivariate exposure studies ( Limitation: Little evidence distinguished potentially preventable or modifiable health care use from overall use. Conclusion: A combination of characteristics can be useful for identifying HNHC patients. Because of the complexity of their conditions and circumstances, improving their quality of care will likely also require an individualized assessment of care needs and availability of support services. Primary funding source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42020161179).
Language	English
Publishing date	2022-11-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M21-4562
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Article ; Online: Interventions to Improve Outcomes for High-Need, High-Cost Patients: A Systematic Review and Meta-Analysis.

Chang, Eva / Ali, Rania / Seibert, Julie / Berkman, Nancy D

Journal of general internal medicine

2022 Volume 38, Issue 1, Page(s) 185–194

Abstract: Background: Chronic disease patients who are the greatest users of healthcare services are often referred to as high-need, high-cost (HNHC). Payers, providers, and policymakers in the United States are interested in identifying interventions that can ... ...

Abstract	Background: Chronic disease patients who are the greatest users of healthcare services are often referred to as high-need, high-cost (HNHC). Payers, providers, and policymakers in the United States are interested in identifying interventions that can modify or reduce preventable healthcare use among these patients, without adversely impacting their quality of care and health. We systematically reviewed the evidence on the effectiveness of complex interventions designed to change the healthcare of HNHC patients, modifying cost and utilization, as well as clinical/functional, and social risk factor outcomes. Methods: We searched 8 electronic databases (January 2000 to March 2021) and selected non-profit organization and government agency websites for randomized controlled trials and observational studies with comparison groups that targeted HNHC patients. Two investigators independently screened each study and abstracted data into structured forms. Study quality was assessed using standard risk of bias tools. Random-effects meta-analysis was conducted for outcomes reported by at least 3 comparable samples. Results: Forty studies met our inclusion criteria. Interventions were heterogenous and classified into 7 categories, reflecting the predominant service location/modality (home, primary care, ambulatory intensive caring unit [aICU], emergency department [ED], community, telephonic/mail, and system-level). Home-, primary care-, and ED-based interventions resulted in reductions in high-cost healthcare services (ED and hospital use). ED-based interventions also resulted in greater use of primary care. Primary care- and ED-based interventions reduced costs. System-level transformation interventions did not reduce costs. Discussion: We found limited evidence of intervention effectiveness in relation to cost and use, and additional evidence is needed to strengthen our confidence in the findings. Few studies reported patient clinical/functional or social risk factor outcomes (e.g., homelessness) or sufficient details for determining why individual interventions work, for whom, and when. Future evaluations could provide additional insights, by including intermediate process outcomes and patients' experiences, in assessing the impact of these complex interventions. Prospero registration number: CRD42020161179.
MeSH term(s)	Humans ; United States ; Delivery of Health Care ; Health Services ; Emergency Service, Hospital ; Emergency Medical Services
Language	English
Publishing date	2022-10-11
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-022-07809-6
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Book ; Online: Management and outcomes of binge-eating disorder

Berkman, Nancy D

(Comparative effectiveness review ; number 160 ; AHRQ publication ; no. 15(16)-EHC030-EF)

2015

Abstract: OBJECTIVES: To evaluate the effectiveness and comparative effectiveness of treatments for patients with binge-eating disorder (BED) and bariatric surgery patients and children with loss-of-control (LOC) eating. Studies of BED therapies include ... ...

Institution	RTI International-University of North Carolina Evidence-based Practice Center, Effective Health Care Program (U.S.), United States. / Agency for Healthcare Research and Quality,
Author's details	prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators, Nancy D. Berkman, Kimberly A. Brownley, Christine M. Peat, Kathleen N. Lohr, Katherine E. Cullen, Laura C. Morgan, Carla M. Bann, Ina F. Wallace, Cynthia M. Bulik
Series title	Comparative effectiveness review ; number 160 AHRQ publication ; no. 15(16)-EHC030-EF
Abstract	OBJECTIVES: To evaluate the effectiveness and comparative effectiveness of treatments for patients with binge-eating disorder (BED) and bariatric surgery patients and children with loss-of-control (LOC) eating. Studies of BED therapies include pharmacological interventions, psychological and behavioral interventions, or combinations of approaches. We examined whether treatment effectiveness differed in patient subgroups and described course of illness for BED and LOC eating. DATA SOURCES: We searched MEDLINE(r), EMBASE(r), the Cochrane Library, Academic OneFile, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) through January 19, 2015. Eligible studies included randomized controlled trials (RCTs), nonrandomized trials, meta-analyses, and, for course of illness, cohort and case-control studies. REVIEW METHODS: Pairs of reviewers independently selected, extracted data from, and rated the risk of bias of relevant studies; they graded the strength of evidence using established criteria. We conducted meta-analysis for some treatment outcomes. RESULTS: Of 52 included RCTs of treatment; 48 concerned BED therapy. Course-of-illness evidence came from 15 observational studies. We examined four major outcomes: binge eating and abstinence, eating-related psychopathology, weight, and general psychological and other outcomes. Second-generation antidepressants (as a class), topiramate (an anticonvulsant), and lisdexamfetamine (a stimulant) were superior to placebo in achieving abstinence and reducing binge episodes and/or binge days and eating-related obsessions and compulsions. Second-generation antidepressants decreased depression. Topiramate and lisdexamfetamine produced weight reduction in study populations whose members were virtually all overweight or obese. A few formats of cognitive behavioral therapy (CBT)--therapist led, partially therapist led, and guided self-help--were superior to placebo in achieving abstinence and reducing binge frequency. CBT for BED was generally ineffective for reducing weight or depression in this population. Therapist-led CBT was not superior to either partially therapist-led CBT or structured self-help CBT for binge-eating and weight outcomes. Behavioral weight loss treatment produced greater weight loss than CBT at the end of treatment but not over the longer run. Topiramate, fluvoxamine, and lisdexamfetamine were associated with sleep disturbance, including insomnia; topiramate and lisdexamfetamine were associated with sympathetic nervous system arousal and headache. We found no evidence on bariatric surgery patients. Treatments for LOC eating in children did not achieve superior weight reduction outcomes. Evidence on the course of either illness was limited. Early adolescent BED and LOC eating predicts such behaviors in the future. CONCLUSIONS: BED patients may benefit from treatment with second-generation antidepressants, lisdexamfetamine, topiramate, and CBT. Additional studies should address other treatments, combinations of treatment, and comparisons between treatments; treatment for postbariatric surgery patients and children; and the course of these illnesses.
MeSH term(s)	Binge-Eating Disorder/therapy ; Treatment Outcome
Language	English
Size	1 online resource (1 PDF file (various pagings)) :, illustrations.
Document type	Book ; Online
Database	Catalogue of the US National Library of Medicine (NLM)

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Book ; Online: Screening for speech and language delays and disorders in children age 5 years or younger

Berkman, Nancy D

a systematic review for the U.S. Preventive Services Task Force

(Evidence synthesis ; number 120 ; AHRQ publication ; no. 13-05197-EF-1)

2015

Abstract: PURPOSE: To evaluate the evidence on screening and treating children for speech and language delays or disorders for the U.S. Preventive Services Task Force (USPSTF). DATA SOURCES: PubMed/MEDLINE(r), the Cochrane Library, PsycInfo(r), ClinicalTrials.gov, ...

Institution	United States. / Agency for Healthcare Research and Quality, RTI International-University of North Carolina Evidence-based Practice Center, U.S. Preventive Services Task Force
Author's details	prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by RTI International--University of North Carolina Evidence-based Practice Center ; investigators, Nancy D. Berkman, Ina Wallace, Linda Watson, Tamera Coyne-Beasley, Katie Cullen, Charles Wood, Kathleen N. Lohr
Series title	Evidence synthesis ; number 120 AHRQ publication ; no. 13-05197-EF-1
Abstract	PURPOSE: To evaluate the evidence on screening and treating children for speech and language delays or disorders for the U.S. Preventive Services Task Force (USPSTF). DATA SOURCES: PubMed/MEDLINE(r), the Cochrane Library, PsycInfo(r), ClinicalTrials.gov, HSRProj, the World Health Organization International Clinical Trials Registry Platform, and reference lists of published literature (through July 2014). STUDY SELECTION: Two investigators independently selected studies reporting on benefits and harms of screening; accuracy of screening tools compared with diagnostic evaluations; and benefits or harms of treatment of speech and language delays or disorders compared with placebo, watchful waiting, or wait-list interventions. To provide context for evaluating our Key Questions, we also included studies describing screening instruments and risk factors for speech and language delays or disorder. DATA EXTRACTION: One reviewer extracted data and a second checked accuracy. Two independent reviewers assigned quality ratings using predefined criteria. DATA SYNTHESIS: No included studies examined the effects of screening on speech and language or other functional outcomes. We included 23 studies evaluating the accuracy of speech and language screening in primary care settings to identify children for diagnostic evaluations and interventions. Among instruments in 13 studies in which parents rated their children's skills, sensitivity ranged from 50 to 94 percent and specificity ranged from 45 to 96 percent. Of the three instruments widely used in the United States, the MacArthur Bates Communication Development Inventory (CDI) and the Language Development Survey (LDS) outperformed the Ages and Stages Questionnaire (ASQ) Communication Domain, especially in terms of their specificity, correctly identifying, on average, 82 percent (CDI) and 91 percent (LDS) compared with 58 percent (ASQ) of children without a language disorder. The ASQ and CDI have versions for infants, toddlers, and preschool-age children, with the CDI being more robust across age groups. The accuracy of professionally or paraprofessionally administered instruments was more variable across studies, and many did not perform as well as parent-rated instruments. Because few studies examined the same instrument in different populations or in different ages, it is unclear how professionally or paraprofessionally administered instruments for multiple ages fare more broadly or whether there is an optimal age for screening. We found no studies addressing adverse effects of screening, such as deleterious consequences of false conclusions from screening. We also found no studies concerning the role of enhanced surveillance by a primary care provider. We included 13 studies examining treatment for speech and language delays or disorders. Although the treatment approaches sometimes overlap, we organized our findings by outcome: language (including expressive and receptive language and more specific aspects of language, such as vocabulary, syntax/morphology, and narratives), speech sounds (including articulation, phonology, and speech intelligibility), and fluency (stuttering). Although results were mixed, the majority of studies found treatment to be effective. Characteristics of effective studies include higher intensity, treating children with more severe delays, and individualizing treatment to the child. We found little evidence concerning other functional outcomes or adverse effects of treatment. Risk factors that were generally associated with speech and language delays or disorders in multivariate analyses of cohort populations included being male, a family history of speech and language concerns, and lower levels of parental educational achievement. LIMITATIONS: As in the earlier review, we did not find any well-conducted trials that could address our overarching question of whether screening leads to improved outcomes. Many screening studies do not include unselected samples from the population but rather participants with and without language delays. Intervention studies did not consistently control for additional community services that children may have been receiving and varied greatly in treatment approach and outcome measurement. Also, because young children with disabilities are entitled to treatment, it may not be possible for future studies in the United States to examine treatment versus no treatment. CONCLUSION: Our review yields evidence that two parent-rated screening instruments, the CDI and LDS, can accurately identify children for diagnostic evaluations and interventions and likely can be interpreted with little difficulty in the primary care setting. Some treatments for young children identified with speech and language delays and disorders may be effective.
MeSH term(s)	Language Disorders/diagnosis ; Speech Disorders/diagnosis ; Child, Preschool ; Mass Screening ; Early Intervention (Education) ; Treatment Outcome
Language	English
Size	1 online resource (1 PDF file (viii, 210 pages)) :, illustrations.
Document type	Book ; Online
Note	Title from PDF title page. ; "Contract No. HHSA-290-2012-00015-I, Task Order No. 2."
Database	Catalogue of the US National Library of Medicine (NLM)

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Book ; Online: Otitis media with effusion: comparative effectiveness of treatments

Berkman, Nancy D

(Comparative effectiveness review ; number 101 ; AHRQ publication ; no. 13-EHC091-EF)

2013

Abstract: OBJECTIVES: To compare benefits and harms of strategies currently in use for managing otitis media with effusion (OME). Treatment for OME may include single approaches alone or combinations of two or more approaches. We compared benefits and harms among ... ...

Institution	United States. / Agency for Healthcare Research and Quality, Research Triangle Institute-University of North Carolina Evidence-based Practice Center,
Author's details	investigators, Nancy D. Berkman [and 7 others]
Series title	Comparative effectiveness review ; number 101 AHRQ publication ; no. 13-EHC091-EF
Abstract	OBJECTIVES: To compare benefits and harms of strategies currently in use for managing otitis media with effusion (OME). Treatment for OME may include single approaches alone or combinations of two or more approaches. We compared benefits and harms among these treatments: tympanostomy tubes (TT), myringotomy (myr), adenoidectomy (adenoid), autoinflation (auto), oral or nasal steroids, complementary and alternative medicine (CAM), and watchful waiting (WW). We included comparisons of treatment effectiveness in subgroups of patients with OME, and whether outcome differences were related to factors affecting health care delivery or the receipt of pneumococcal vaccine inoculation. DATA SOURCES: We identified five recent systematic reviews a priori and searched MEDLINE,(r) Embase,(r) the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL(r)), from root through August 13, 2012, for additional studies. Eligible studies included randomized controlled trials (RCTs), nonrandomized trials, and cohort studies. REVIEW METHODS: Eligible studies included at least two arms comparing the treatments described above. Pairs of reviewers independently selected, extracted data from, and rated the risk of bias of relevant studies; they graded the strength of evidence using established criteria. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively. RESULTS: We identified 59 studies through the earlier reviews and our independent searches. Generally, studies examined interventions in otherwise healthy, noninfant children. We did not find any eligible studies covering CAM. Findings are reported for clinical and functional outcomes, and harms. Variation in length of TT retention corresponded to whether TT were designed to be short versus long term, but variation in TT type was not related to improved OME and hearing outcomes. TT decreased OME for 2 years compared with WW or myr, and improved hearing for 6 months compared with WW. OME resolution was more likely with adenoid than no treatment at 12 months. Adenoid and myr were superior to myr alone in relation to OME and hearing outcomes at 24 months. Adenoid and TT were superior to WW for hearing outcomes at 24 months. Auto was superior to standard treatment at improving OME at 1 month. We found no benefits from oral steroids at 2 months, or topical steroids at 9 months. In relation to functional outcomes, TT and WW did not differ in long-term language, cognitive or academic outcomes. Tympanosclerosis and otorrhea were more common in ears with TT. Adenoid increased the risk of postsurgical hemorrhage. In one study of a subgroup, adults receiving auto were more likely to recover from OME than those in the control group at one month. We found no studies examining the influence of any health care factors on treatment effectiveness. CONCLUSIONS: There is evidence that both TT and adenoid reduce OME and improve hearing in the short term, but both treatments also have associated harms. Large, well-controlled studies could help resolve the risk-benefit ratio by measuring AOM recurrence, functional outcomes, quality of life measures, and long-term outcomes. Finally, additional research is needed to support treatment decisions in subpopulations, particularly those with comorbidities and those who have received a pneumococcal vaccine inoculation.
MeSH term(s)	Otitis Media with Effusion/therapy ; Comparative Effectiveness Research
Language	English
Size	1 online resource (1 PDF file (various pagings)) :, illustrations
Document type	Book ; Online
Note	Title from PDF title page. ; "Contract No. 290-2007-10056-I."
Database	Catalogue of the US National Library of Medicine (NLM)

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