eCQM Title | Appropriate Treatment for Upper Respiratory Infection (URI) |
||
---|---|---|---|
eCQM Identifier (Measure Authoring Tool) | 154 | eCQM Version Number | 9.2.000 |
NQF Number | Not Applicable | GUID | e455fac0-f2cb-4074-a351-1e68a90fb7cf |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | National Committee for Quality Assurance | ||
Measure Developer | National Committee for Quality Assurance | ||
Endorsed By | None | ||
Description |
Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event. |
||
Copyright |
This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2019 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 copyright 2019 World Health Organization. All Rights Reserved. |
||
Disclaimer |
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. |
||
Measure Scoring | Proportion | ||
Measure Type | Process | ||
Stratification |
• 3 months-17 years • 18-64 years • 65 years and older |
||
Risk Adjustment |
None |
||
Rate Aggregation |
None |
||
Rationale |
Most URI, also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often, antibiotics are prescribed inappropriately, which can lead to antibiotic resistance (when antibiotics can no longer cure bacterial infections). In the United States, at least 2 million antibiotic-resistant illnesses and 23,000 deaths occur each year, at a cost to the U.S. economy of at least $30 billion. |
||
Clinical Recommendation Statement |
American Family Physician (Fashner, Ericson, and Werner, Khilberg 2012) - Antibiotics should not be used for the treatment of cold symptoms in children or adults. (A) - Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. (A) - Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults. (B) |
||
Improvement Notation |
Higher score indicates better quality |
||
Reference |
Centers for Disease Control and Prevention. (2018). Be antibiotics aware: Smart use, best care. Retrieved from https://www.cdc.gov/features/antibioticuse/ |
||
Reference |
Fashner, J., Ericson, K., & Werner, S. (2012). Treatment of the common cold in children and adults. American Family Physician, 86(2), 153-159. |
||
Reference |
Harris, A.M., Hicks, L.A., Qaseem, A. (2016.) "Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and The Centers for Disease Control and Prevention." Ann Intern Med. 164(6):425-434. |
||
Definition |
None |
||
Guidance |
This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is a episode-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
||
Transmission Format |
TBD |
||
Initial Population |
Outpatient visits, telephone visits, online assessments, observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older. |
||
Denominator |
Equals Initial Population |
||
Denominator Exclusions |
Exclude URI episodes when the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had a new or refill prescription of antibiotics in the 30 days prior to or on the episode date. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care overlapping with the measurement period. |
||
Numerator |
URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection |
||
Numerator Exclusions |
Not Applicable |
||
Denominator Exceptions |
None |
||
Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3 return EncounterWithURI.QualifyingEncounter
"Initial Population"
"In Hospice" union "Encounter with Upper Respiratory Infection and Antibiotics Active 30 Days Prior" union "Encounter with Competing Diagnosis for Upper Respiratory Infection" union "Encounter with Comorbid Condition for Upper Respiratory Infection Prior"
"Encounter with Upper Respiratory Infection" EncounterWithURI without ["Medication, Order": "Antibiotic Medications for Pharyngitis"] OrderedAntibiotic such that OrderedAntibiotic.authorDatetime 3 days or less on or after start of EncounterWithURI.QualifyingEncounter.relevantPeriod return EncounterWithURI.QualifyingEncounter
None
None
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3 and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 17 return EncounterWithURI.QualifyingEncounter
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 64] return EncounterWithURI.QualifyingEncounter
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 return EncounterWithURI.QualifyingEncounter
"Initial Population"
"In Hospice" union "Encounter with Upper Respiratory Infection and Antibiotics Active 30 Days Prior" union "Encounter with Competing Diagnosis for Upper Respiratory Infection" union "Encounter with Comorbid Condition for Upper Respiratory Infection Prior"
( "Encounter with Upper Respiratory Infection" EncounterWithURI with ["Diagnosis": "Comorbid Conditions for Respiratory Conditions"] ComorbidCondition such that start of ComorbidCondition.prevalencePeriod in Interval[start of EncounterWithURI.URI.prevalencePeriod - 1 year, start of EncounterWithURI.URI.prevalencePeriod] return EncounterWithURI.QualifyingEncounter )
( "Encounter with Upper Respiratory Infection" EncounterWithURI with ["Diagnosis": "Competing Conditions for Respiratory Conditions"] CompetingCondition such that CompetingCondition.prevalencePeriod starts 3 days or less on or after day of start of EncounterWithURI.QualifyingEncounter.relevantPeriod return EncounterWithURI.QualifyingEncounter )
from "Qualifying Encounter" QualifyingEncounter, ["Diagnosis": "Upper Respiratory Infection"] URI where URI.prevalencePeriod starts during QualifyingEncounter.relevantPeriod or URI.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic such that ActiveAntibiotic.relevantPeriod overlaps Interval[Global."ToDate" ( ( start of EncounterWithURI.URI.prevalencePeriod ) - 30 days ), start of EncounterWithURI.URI.prevalencePeriod] return EncounterWithURI.QualifyingEncounter
exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice where ( DischargeHospice.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or DischargeHospice.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and DischargeHospice.relevantPeriod ends during "Measurement Period" ) or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder where HospiceOrder.authorDatetime during "Measurement Period" ) or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed where HospicePerformed.relevantPeriod overlaps "Measurement Period" )
"Initial Population" InitialPopulation where Hospice."Has Hospice"
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3 return EncounterWithURI.QualifyingEncounter
"Encounter with Upper Respiratory Infection" EncounterWithURI without ["Medication, Order": "Antibiotic Medications for Pharyngitis"] OrderedAntibiotic such that OrderedAntibiotic.authorDatetime 3 days or less on or after start of EncounterWithURI.QualifyingEncounter.relevantPeriod return EncounterWithURI.QualifyingEncounter
( ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Emergency Department Visit"] union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"] union ["Encounter, Performed": "Hospital Observation Care - Initial"] union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"] union ["Encounter, Performed": "Telephone Visits"] union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"] ) ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3 and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 17 return EncounterWithURI.QualifyingEncounter
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 64] return EncounterWithURI.QualifyingEncounter
"Encounter with Upper Respiratory Infection" EncounterWithURI with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 return EncounterWithURI.QualifyingEncounter
months between ToDate(BirthDateTime)and ToDate(AsOf)
years between ToDate(BirthDateTime)and ToDate(AsOf)
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
None |
---|