Appropriate Treatment for Upper Respiratory Infection (URI)
Compare Versions of: "Appropriate Treatment for Upper Respiratory Infection (URI)"
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| Measure Information | 2022 Performance Period | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period |
|---|---|---|---|---|
| Title | Appropriate Treatment for Upper Respiratory Infection (URI) | Appropriate Treatment for Upper Respiratory Infection (URI) | Appropriate Treatment for Upper Respiratory Infection (URI) | Appropriate Treatment for Upper Respiratory Infection (URI) |
| CMS eCQM ID | CMS154v10 | CMS154v11 | CMS154v12 | CMS154v13 |
| CBE ID* | Not Applicable | Not Applicable | Not Applicable | Not Applicable |
| MIPS Quality ID | 065 | 065 | 065 | 065 |
| Measure Steward | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance |
| 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 order |
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 |
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 |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process | Process |
| Stratification | *See CMS154v10.html | *See CMS154v11.html |
- 3 months-17 years - 18-64 years - 65 years and older |
- 3 months-17 years - 18-64 years - 65 years and older |
| Risk Adjustment | *See CMS154v10.html | *See CMS154v11.html |
None |
None |
| Rationale | *See CMS154v10.html | *See CMS154v11.html |
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 2.8 million antibiotic-resistant illnesses and 35,000 deaths occur each year (Centers for Disease Control and Prevention [CDC], 2020). |
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 2.8 million antibiotic-resistant illnesses and 35,000 deaths occur each year (Centers for Disease Control and Prevention [CDC], 2020). |
| Clinical Recommendation Statement | *See CMS154v10.html | *See CMS154v11.html |
American Family Physician (Fashner, Ericson, and Werner, 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) Institute for Clinical Systems Improvement (Short, et al., 2017) The ICSI work group does not recommend antibiotics for treatment of common cold symptoms in children and adults. |
American Family Physician (Fashner, Ericson, & Werner, 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) Institute for Clinical Systems Improvement (ICSI) (Short et al., 2017) The ICSI work group does not recommend antibiotics for treatment of common cold symptoms in children and adults. |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS154v10.html | *See CMS154v11.html |
None |
None |
| 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. 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 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. |
This is an episode of care measure that examines all eligible episodes for the patient. 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 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. 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 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 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 |
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 from January 1 to December 28 of the measurement period for patients 3 months of age and older |
Outpatient visits, telephone visits, virtual encounter (i.e., e-visit or virtual check-in), or emergency department visits with a diagnosis of URI from January 1 to December 28 of the measurement period for patients 3 months of age and older |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions |
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. |
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 where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude URI episodes where 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 where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date. |
| 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 three 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 three days after the outpatient visit, telephone visit, virtual encounter, or emergency department visit for an upper respiratory infection |
| 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 CMS154v10
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
Updated the rationale to align with current evidence.
Measure Section: Rationale
Source of Change: Measure Lead
Updated references.
Measure Section: Reference
Source of Change: Annual Update
Updated the guidance to clarify the measure intent and support implementation.
Measure Section: Guidance
Source of Change: Measure Lead
Added clarifying language to 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
Restructured the return on the Encounter with Competing Diagnosis for Upper Respiratory Infection definition to reduce confusion for implementers.
Measure Section: Definitions
Source of Change: Measure Lead
Revised the definitions to base timing of 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
Updated Hospice CQL Library to version 3.0.000.
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
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 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
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 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
Added value set Medical Disability Exam (2.16.840.1.113883.3.464.1003.101.12.1073) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Preventive Care Services-Individual Counseling (2.16.840.1.113883.3.464.1003.101.12.1026) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Preventive Care Services - Group Counseling (2.16.840.1.113883.3.464.1003.101.12.1027) based on change in measure requirements/measure specification.
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
Added value set Online Assessments (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
Added direct reference code CPT code (99217) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030) based on based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead