Using an epidemiological model to investigate unwarranted variation: the case of ventilation tubes for otitis media with effusion in England

Laura Schang, de Poli Chiara, Mara Airoldi, Alec Morton, Natalie Bohm, Monica Lakhanpaul, Anne Schilder, Gwyn Bevan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: To investigate unwarranted variation in ventilation tube insertions for otitis media with effusion in children in England. This procedure is known to be 'overused' from clinical audits, as only one in three ventilation tube insertions conforms to the appropriateness criteria of the National Institute for Health and Care Excellence (NICE); but audits cannot identify the scale of 'underuse' - i.e. patients who would benefit but are not treated.
Methods:
To explore both 'underuse' and 'overuse' of ventilation tubes for otitis media with effusion, we developed an epidemiological model based on: definitions of children with otitis media with effusion expected to benefit from ventilation tubes according to NICE guidance; epidemiological and clinical information from a systematic review; and expert judgement. A range of estimates was derived using Monte Carlo simulation and compared with the number of ventilation tubes provided in the English National Health Service in 2010.
Results:
About 32,200 children in England would be expected to benefit from ventilation tubes for otitis media with effusion per year (between 20,411 and 45,231 with 90% certainty). The observed number of ventilation tubes for otitis media with effusion-associated diagnoses was 16,824.
Conclusions:
The expected population capacity to benefit from ventilation tubes for otitis media with effusion based on NICE guidance appeared to exceed, by far, the number of ventilation tubes provided in the English National Health Service. So, while there is known 'overuse', there also may be substantial 'underuse' of ventilation tubes for otitis media with effusion if NICE criteria were applied. Future investigations of unwarranted variation should, therefore, not only focus on the patients who are treated but also consider the potential for benefit at the population level.
LanguageEnglish
Pages236-244
Number of pages9
JournalJournal of Health Services Research & Policy
Volume19
Issue number4
Early online date29 Jul 2014
DOIs
Publication statusPublished - 1 Oct 2014

Fingerprint

Otitis Media with Effusion
England
Ventilation
National Institutes of Health (U.S.)
Delivery of Health Care
National Health Programs
Clinical Audit
Population

Keywords

  • epidemiological models
  • otitis media with effusion
  • unwarranted variations
  • ventilation tubes

Cite this

Schang, Laura ; Chiara, de Poli ; Airoldi, Mara ; Morton, Alec ; Bohm, Natalie ; Lakhanpaul, Monica ; Schilder, Anne ; Bevan, Gwyn. / Using an epidemiological model to investigate unwarranted variation : the case of ventilation tubes for otitis media with effusion in England. In: Journal of Health Services Research & Policy . 2014 ; Vol. 19, No. 4. pp. 236-244.
@article{2fa02479db9f4681bcef5f8676c126f2,
title = "Using an epidemiological model to investigate unwarranted variation: the case of ventilation tubes for otitis media with effusion in England",
abstract = "Objectives: To investigate unwarranted variation in ventilation tube insertions for otitis media with effusion in children in England. This procedure is known to be 'overused' from clinical audits, as only one in three ventilation tube insertions conforms to the appropriateness criteria of the National Institute for Health and Care Excellence (NICE); but audits cannot identify the scale of 'underuse' - i.e. patients who would benefit but are not treated.Methods:To explore both 'underuse' and 'overuse' of ventilation tubes for otitis media with effusion, we developed an epidemiological model based on: definitions of children with otitis media with effusion expected to benefit from ventilation tubes according to NICE guidance; epidemiological and clinical information from a systematic review; and expert judgement. A range of estimates was derived using Monte Carlo simulation and compared with the number of ventilation tubes provided in the English National Health Service in 2010.Results:About 32,200 children in England would be expected to benefit from ventilation tubes for otitis media with effusion per year (between 20,411 and 45,231 with 90{\%} certainty). The observed number of ventilation tubes for otitis media with effusion-associated diagnoses was 16,824.Conclusions:The expected population capacity to benefit from ventilation tubes for otitis media with effusion based on NICE guidance appeared to exceed, by far, the number of ventilation tubes provided in the English National Health Service. So, while there is known 'overuse', there also may be substantial 'underuse' of ventilation tubes for otitis media with effusion if NICE criteria were applied. Future investigations of unwarranted variation should, therefore, not only focus on the patients who are treated but also consider the potential for benefit at the population level.",
keywords = "epidemiological models, otitis media with effusion, unwarranted variations, ventilation tubes",
author = "Laura Schang and Chiara, {de Poli} and Mara Airoldi and Alec Morton and Natalie Bohm and Monica Lakhanpaul and Anne Schilder and Gwyn Bevan",
year = "2014",
month = "10",
day = "1",
doi = "10.1177/1355819614536886",
language = "English",
volume = "19",
pages = "236--244",
journal = "Journal of Health Services Research & Policy",
issn = "1355-8196",
number = "4",

}

Using an epidemiological model to investigate unwarranted variation : the case of ventilation tubes for otitis media with effusion in England. / Schang, Laura; Chiara, de Poli; Airoldi, Mara; Morton, Alec; Bohm, Natalie; Lakhanpaul, Monica; Schilder, Anne; Bevan, Gwyn.

In: Journal of Health Services Research & Policy , Vol. 19, No. 4, 01.10.2014, p. 236-244.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Using an epidemiological model to investigate unwarranted variation

T2 - Journal of Health Services Research & Policy

AU - Schang, Laura

AU - Chiara, de Poli

AU - Airoldi, Mara

AU - Morton, Alec

AU - Bohm, Natalie

AU - Lakhanpaul, Monica

AU - Schilder, Anne

AU - Bevan, Gwyn

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Objectives: To investigate unwarranted variation in ventilation tube insertions for otitis media with effusion in children in England. This procedure is known to be 'overused' from clinical audits, as only one in three ventilation tube insertions conforms to the appropriateness criteria of the National Institute for Health and Care Excellence (NICE); but audits cannot identify the scale of 'underuse' - i.e. patients who would benefit but are not treated.Methods:To explore both 'underuse' and 'overuse' of ventilation tubes for otitis media with effusion, we developed an epidemiological model based on: definitions of children with otitis media with effusion expected to benefit from ventilation tubes according to NICE guidance; epidemiological and clinical information from a systematic review; and expert judgement. A range of estimates was derived using Monte Carlo simulation and compared with the number of ventilation tubes provided in the English National Health Service in 2010.Results:About 32,200 children in England would be expected to benefit from ventilation tubes for otitis media with effusion per year (between 20,411 and 45,231 with 90% certainty). The observed number of ventilation tubes for otitis media with effusion-associated diagnoses was 16,824.Conclusions:The expected population capacity to benefit from ventilation tubes for otitis media with effusion based on NICE guidance appeared to exceed, by far, the number of ventilation tubes provided in the English National Health Service. So, while there is known 'overuse', there also may be substantial 'underuse' of ventilation tubes for otitis media with effusion if NICE criteria were applied. Future investigations of unwarranted variation should, therefore, not only focus on the patients who are treated but also consider the potential for benefit at the population level.

AB - Objectives: To investigate unwarranted variation in ventilation tube insertions for otitis media with effusion in children in England. This procedure is known to be 'overused' from clinical audits, as only one in three ventilation tube insertions conforms to the appropriateness criteria of the National Institute for Health and Care Excellence (NICE); but audits cannot identify the scale of 'underuse' - i.e. patients who would benefit but are not treated.Methods:To explore both 'underuse' and 'overuse' of ventilation tubes for otitis media with effusion, we developed an epidemiological model based on: definitions of children with otitis media with effusion expected to benefit from ventilation tubes according to NICE guidance; epidemiological and clinical information from a systematic review; and expert judgement. A range of estimates was derived using Monte Carlo simulation and compared with the number of ventilation tubes provided in the English National Health Service in 2010.Results:About 32,200 children in England would be expected to benefit from ventilation tubes for otitis media with effusion per year (between 20,411 and 45,231 with 90% certainty). The observed number of ventilation tubes for otitis media with effusion-associated diagnoses was 16,824.Conclusions:The expected population capacity to benefit from ventilation tubes for otitis media with effusion based on NICE guidance appeared to exceed, by far, the number of ventilation tubes provided in the English National Health Service. So, while there is known 'overuse', there also may be substantial 'underuse' of ventilation tubes for otitis media with effusion if NICE criteria were applied. Future investigations of unwarranted variation should, therefore, not only focus on the patients who are treated but also consider the potential for benefit at the population level.

KW - epidemiological models

KW - otitis media with effusion

KW - unwarranted variations

KW - ventilation tubes

UR - http://hsr.sagepub.com/

U2 - 10.1177/1355819614536886

DO - 10.1177/1355819614536886

M3 - Article

VL - 19

SP - 236

EP - 244

JO - Journal of Health Services Research & Policy

JF - Journal of Health Services Research & Policy

SN - 1355-8196

IS - 4

ER -