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Appropriate Treatment for Upper Respiratory Infection (URI)

Measure Information 2021 Performance Period
CMS Measure ID CMS154v9
NQF Number Not Applicable
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.

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

Measure Steward National Committee for Quality Assurance
Quality 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 a 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.

MIPS Quality ID 065
Meaningful Measure Appropriate Use of Healthcare
Telehealth Eligible Yes
Next Version
Previous Version No Version Available

Compare eCQM Versions

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Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

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Measure Information 2021 Performance Period 2022 Performance Period 2023 Performance Period
Name Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI)
CMS Measure ID CMS154v9 CMS154v10 CMS154v11
NQF Number Not Applicable Not Applicable Not Applicable
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.

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.

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 order

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.

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), 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

Equals Initial Population

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. Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, including the episode date up until the time of the encounter. 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 for any part of the measurement period. Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date but is still active the same day of the encounter.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 for any part of 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

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

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

Not Applicable

Not Applicable

Denominator Exceptions

None

None

None

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

Higher score indicates better quality

Higher score indicates better quality

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 a 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.

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. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

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.

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. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

MIPS Quality ID 065 065 065
Meaningful Measure Appropriate Use of Healthcare Appropriate Use of Healthcare Appropriate Use of Healthcare
Telehealth Eligible Yes Yes Yes
Next Version CMS154v10 CMS154v11 No Version Available
Previous Version No Version Available

Release Notes

Header

  • Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

    Measure Section: eCQM Title

    Source of Change: Measure Lead

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated the description and numerator statements to be episode based for better alignment with the measure intent.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • 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

  • Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated denominator exclusions for upper respiratory infection (URI) 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

  • Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Updated the description and numerator statements to be episode based for better alignment with the measure intent.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated denominator exclusions for upper respiratory infection (URI) 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

  • Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Added 'on or' to the 'Encounter with Competing Diagnosis for Upper Respiratory Infection' definition to allow for same day competing diagnosis.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (Jira): CQM-3789

  • 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 Clinical Quality Language (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

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

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

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 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

  • Value sets Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025); Preventive Care Services - Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023); Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080) added to accommodate the expanded age range of the initial population.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • 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

Last Updated: May 04, 2022