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Appropriate Testing for Pharyngitis

General eCQM Information

CMS Measure ID CMS146v9
NQF Number Not Applicable
Measure Description

The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test

Initial Population Outpatient, telephone, online assessment, observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event among patients 3 years or older
Denominator Statement

Equals Initial Population

Denominator Exclusions

Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date.

Exclude episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date.

Exclude episodes when the patient had hospice care overlapping with the measurement period.

Exclude episodes where the patient had a competing diagnosis within three days after the episode date.

Numerator Statement

A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Steward National Committee for Quality Assurance
Domain Efficiency and Cost Reduction
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Higher score indicates better quality

Guidance

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is an episode-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

Quality ID 66
Meaningful Measure Appropriate Use of Healthcare
Telehealth Eligible Yes
Previous Version

Release Notes

Header

  • Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.

    Measure Section: eCQM Title

    Source of Change: Measure Lead

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated the rationale to remove outdated references and content and to update references.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Standards Update

  • Added more guidance about which eligible episode to include in the measure.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added text to identify the Quality Data Model (QDM) version used in the measure specification.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Added text to indicate whether the measure is patient-based or episode-based.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Revised wording of the initial population statement to reflect measure is episode based for consistency with the measure intent.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Updated denominator exclusions to clarify language regarding eligible encounter types and add an exclusion for competing comorbid condition during the 12 months prior to or on the episode date.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the numerator statement by clarifying that the test should be within 3 days of the episode date to align with the measure logic.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Updated denominator exclusions to clarify language regarding eligible encounter types and add an exclusion for competing comorbid condition during the 12 months prior to or on the episode date.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated timing logic for the follow-up assessment to use 'in Interval' to simplify logic and promote harmonization between measures.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Clinical Quality Language (CQL) Library version update: Updated version number of the Hospice Library (Hospice-2.2.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • QDM v5.5 standards update: Added 'relevantDatetime' attribute to QDM datatypes. 'RelevantDatetime' indicates when the action occurred whereas 'authorDatetime' indicates when the action was recorded.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated CQL expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-5.0.000). Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Deleted 9 RxNorm codes (1148107, 199497, 199620, 199710, 199802, 245240, 245837, 245838, 761979) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Deleted 1 SNOMED CT code (17436001) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Comorbid Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1025): Added Comorbid Conditions for Respiratory Conditions based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080): Added Telephone Visits based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Deleted 29 SNOMED CT codes based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced Value set Discharge Services Observation Care (2.16.840.1.113883.3.464.1003.101.12.1039) with direct reference code CPT Code (99217) to align with best practices for replacing single code value sets with direct reference codes.

    Measure Section: Terminology

    Source of Change: Annual Update

Last Updated: Dec 18, 2020