Appropriate Testing for Pharyngitis
Compare Versions of: "Appropriate Testing for Pharyngitis"
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| Measure Information | 2022 Performance Period | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period |
|---|---|---|---|---|
| Title | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis |
| CMS eCQM ID | CMS146v10 | CMS146v11 | CMS146v12 | CMS146v13 |
| CBE ID* | Not Applicable | Not Applicable | Not Applicable | Not Applicable |
| MIPS Quality ID | 066 | 066 | 066 | 066 |
| Measure Steward | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance |
| 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 |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order on or three days after the episode date and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order on or three days after the episode date and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process | Process |
| Stratification | *See CMS146v10.html | *See CMS146v11.html |
- 3-17 years - 18-64 years - 65 years and older |
- 3-17 years - 18-64 years - 65 years and older |
| Risk Adjustment | *See CMS146v10.html | *See CMS146v11.html |
None |
None |
| Rationale | *See CMS146v10.html | *See CMS146v11.html |
Group A streptococcal (GAS) bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (Shulman et al., 2012). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al., 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance varies but has extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Pfoh et al., 2008). |
Group A streptococcal (GAS) bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (Shulman et al., 2012). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al., 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance varies but has extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Pfoh et al., 2008). |
| Clinical Recommendation Statement | *See CMS146v10.html | *See CMS146v11.html |
Infectious Disease Society of America (2012) The Infectious Diseases Society of America "recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present" |
Infectious Disease Society of America (Shulman et al., 2012) The Infectious Diseases Society of America "recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present" |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS146v10.html | *See CMS146v11.html |
None |
None |
| Guidance |
This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. The intent is to determine whether antibiotics are being dispensed appropriately. Antibiotics should only be dispensed if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be dispensed for viral infections. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event during the measurement period. 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. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on the episode date through 3 days after the episode date. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order 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. |
This is an episode of care measure that examines all eligible episodes for the patient. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on or three days after the episode date. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order from January 1 to December 28 of 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. |
This is an episode of care measure that examines all eligible episodes for the patient. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on or three days after the episode date. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order from January 1 to December 28 of 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. |
| Initial Population |
Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event on or within 3 days after the episode date among patients 3 years or older |
Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis and an antibiotic order on or within 3 days after the episode date among patients 3 years or older |
Outpatient, telephone, online assessment (i.e., e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis from January 1 to December 28 of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older |
Outpatient, telephone, virtual encounter (i.e., e-visit or virtual check-in), or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis from January 1 to December 28 of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions |
Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date, or had an active prescription on the episode date. Exclude episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude episodes when the patient had hospice care for any part of the measurement period. Exclude episodes where the patient had a competing diagnosis on or within three days after the episode date. |
Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date, or had an active prescription on the episode date. Exclude episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude episodes when the patient had hospice care for any part of the measurement period. Exclude episodes where the patient had a competing diagnosis on or within three days after the episode date. |
Exclude pharyngitis episodes when the patient had hospice care for any part of the measurement period. Exclude pharyngitis episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude pharyngitis episodes where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude pharyngitis episodes where the patient had a competing diagnosis on or three days after the episode date. |
Exclude pharyngitis episodes when the patient had hospice care for any part of the measurement period. Exclude pharyngitis episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude pharyngitis episodes where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude pharyngitis episodes where the patient had a competing diagnosis on or three days after the episode date. |
| Numerator |
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 |
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 |
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 |
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 |
Not Applicable |
Not Applicable |
Not Applicable |
| Denominator Exceptions |
None |
None |
None |
None |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS146v10
Header
Updated the eCQM version number.
Measure Section: eCQM Version Number
Source of Change: Annual Update
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Revised the guidance language to further clarify the measure intent.
Measure Section: Guidance
Source of Change: Measure Lead
Added clarifying language to the guidance section of episode-based measures to define the episode.
Measure Section: Guidance
Source of Change: Measure Lead
Revised language in the inital population to reduce ambiguity and improve clarity.
Measure Section: Initial Population
Source of Change: Measure Lead
Replaced 'overlaps' or 'overlapping' in the denominator exclusions with plain language to clarify the measure intent.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Revised the denominator exclusions language to reduce ambiguity in the exclusions.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Logic
Harmonized the types of encounters considered denominator eligible to align with the measure intent and measures of similar type.
Measure Section: Initial Population
Source of Change: Measure Lead
Revised the definition name Encounter With Pharyngitis or Tonsillitis to Encounter With Pharyngitis or Tonsillitis With Antibiotic to provide more clarity.
Measure Section: Definitions
Source of Change: Measure Lead
Revised the definitions to base timing of the measure criteria on the time of the encounter to align with the measure intent to use encounter information to determine valid time intervals for conditions/medications.
Measure Section: Definitions
Source of Change: Measure Lead
Added online assessments as appropriate encounters based on the increased use of telehealth services.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Restructured the return clause to return only encounter related information to reduce confusion for implementers.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Simplified the numerator definition logic to improve clarity.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.
Measure Section: Multiple Sections
Source of Change: Standards Update
Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.
Measure Section: Multiple Sections
Source of Change: Standards Update
Updated Hospice CQL Library to version 3.0.000.
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): Added 2 RxNorm codes (2387078, 2387079) based on terminology update. Deleted 24 RxNorm codes based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Group A Streptococcus Test (2.16.840.1.113883.3.464.1003.198.12.1012): Added 1 LOINC code (96331-4) 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 9 SNOMED CT codes (22607003, 266355005, 307202004, 74610006, 76157009, 782761005, 789056000, 789057009, 860803004) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Added 14 ICD-10-CM codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080): Added 5 SNOMED CT codes (185317003, 314849005, 386472008, 386473003, 401267002) 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): Added 1269 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback or based on terminology update. Deleted 1159 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Added 5 ICD-10-CM codes (B60.00, B60.01, B60.02, B60.03, B60.09) based on review by technical experts, SMEs, and/or public feedback. Deleted 37 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Online Assessment (2.16.840.1.113883.3.464.1003.101.12.1089) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Replaced value set Medical Disability Exam (2.16.840.1.113883.3.464.1003.101.1233) with value set Medical Disability Exam (2.16.840.1.113883.3.464.1003.101.12.1073) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Observation (2.16.840.1.113883.3.464.1003.101.12.1086) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead