| Title |
Appropriate Testing for Pharyngitis
|
Appropriate Testing for Pharyngitis
|
Appropriate Testing for Pharyngitis
|
| CMS eCQM ID |
CMS146v11
|
CMS146v12
|
CMS146v13
|
| CBE ID* |
Not Applicable
|
Not Applicable
|
Not Applicable
|
| MIPS Quality ID |
066
|
066
|
066
|
| Measure Steward |
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 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
... Show more >
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
Show less |
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
Show more >
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
Show less |
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
Show more >
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
Show less |
| Measure Scoring |
Proportion measure
|
Proportion measure
|
Proportion measure
|
| Measure Type |
Process
|
Process
|
Process
|
| Stratification |
*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
CMS146v11.html
|
None
|
None
|
| Rationale |
*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).
Show more >
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).
Show less |
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).
Show more >
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).
Show less |
| Clinical Recommendation Statement |
*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"
Show more >
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"
Show less |
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"
Show more >
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"
Show less |
| Improvement Notation |
Higher score indicates better quality
|
Higher score indicates better quality
|
Higher score indicates better quality
|
| Definition |
*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 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.
Show more >
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.
Show less |
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.
Show more >
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.
Show less |
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.
Show more >
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.
Show less |
| 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 or tonsillitis and an antibiotic order on or within 3 days after the episode date among patients 3 years or older
... Show more >
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
Show less |
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
Show more >
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
Show less |
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
Show more >
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
Show less |
| Denominator |
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.
Show more >
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.
Show less |
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.
Show more >
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.
Show less |
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.
Show more >
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.
Show less |
| 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
|
| Numerator Exclusions |
Not Applicable
|
Not Applicable
|
Not Applicable
|
| Denominator Exceptions |
None
|
None
|
None
|
| Telehealth Eligible |
Yes
|
Yes
|
Yes
|
| Next Version |
|
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No Version Available
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| Previous Version |
No Version Available
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