Appropriate Treatment for Upper Respiratory Infection (URI)
Compare Versions of: "Appropriate Treatment for Upper Respiratory Infection (URI)"
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| Measure Information | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period | 2026 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 | CMS154v11 | CMS154v12 | CMS154v13 | CMS154v14 |
| 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 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 |
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 | Proportion | Proportion | Proportion |
| Measure Type | Process | Process | Process | Process |
| Stratification | *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 |
- 3 months-17 years - 18-64 years - 65 years and older |
| Risk Adjustment | *See CMS154v11.html |
None |
None |
None |
| Rationale | *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). Show more >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). Show less |
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). Show more >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). Show less |
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). Show more >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). Show less |
| Clinical Recommendation Statement | *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. Show more >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. Show less |
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. Show more >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. Show less |
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. Show more >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. Show less |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS154v11.html |
None |
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 5.6. 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. 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. Show less |
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. Show more >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. Show less |
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. Show more >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. Show less |
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. Show more >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. Show less |
| 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 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 |
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 but is still active the same day of the encounter.E...xclude 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. Show more >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. Show less |
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. Show more >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. Show less |
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. Show more >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. Show less |
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. Show more >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. Show less |
| 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 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 |
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 |
None |
| 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 CMS154v14
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Header
TRN | Measure Section | Source of Change |
|---|---|---|
Changed the 'eCQM Identifier (Measure Authoring Tool)' field name to 'CMS ID' based on tooling updates. | CMS ID | Standards/Technical Update |
Updated the eCQM version number. | eCQM Version Number | Annual Update |
Updated the generic measurement period from 'January 1, 20XX through December 31, 20XX' to specify 'January 1, 2026 through December 31, 2026' based on tooling updates. | Measurement Period | Standards/Technical Update |
Updated copyright. | Copyright | Annual Update |
Changed 'Numerator Exclusions' field to read 'None' instead of 'Not Applicable' when no exclusions are present. | Numerator Exclusions | Standards/Technical Update |
Logic
TRN | Measure Section | Source of Change |
|---|---|---|
Updated Measure Primary CQL Library Name from 'AppropriateTreatmentforUpperRespiratoryInfectionURI' to 'CMS154AppropriateTreatmentforURI' for alignment with the CQL Style Guide. | Definitions | Standards/Technical Update |
Updated the version number of the Global Common Functions Library to 9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.' | Definitions | Annual Update |
Updated the version number of the HospiceQDM library to 7.0.000. | Definitions | Annual Update |
Updated Measure Primary CQL Library Name from 'AppropriateTreatmentforUpperRespiratoryInfectionURI' to 'CMS154AppropriateTreatmentforURI' for alignment with the CQL Style Guide. | Functions | Standards/Technical Update |
Updated the version number of the Global Common Functions Library to 9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.' | Functions | Annual Update |
Updated the version number of the HospiceQDM library to 7.0.000. | Functions | Annual 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.
TRN | Measure Section | Source of Change |
|---|---|---|
Value Set 'Antibiotic Medications for Upper Respiratory Infection' (2.16.840.1.113883.3.464.1003.1190): Added 7 RxNorm codes (242807, 2688632, 2688634, 313252, 313254, 757460, 757466) based on review by technical experts, SMEs and/or public feedback. Deleted 2 RxNorm codes (1648755, 577378) based on review by technical experts, SMEs and/or public feedback. | Terminology | Annual Update |
Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 1 SNOMEDCT code (185349003) based on review by technical experts, SMEs and/or public feedback. | Terminology | Annual Update |
Replaced Value Set 'ONC Administrative Sex' (2.16.840.1.113762.1.4.1) with Value Set 'Federal Administrative Sex' (2.16.840.1.113762.1.4.1021.121) to represent Supplemental Data Element 'SDE Sex' based on revised standards. | Terminology | Standards/Technical Update |
Value Set 'Telephone Visits' (2.16.840.1.113883.3.464.1003.101.12.1080): Added 8 CPT codes (98009, 98013, 98010, 98011, 98014, 98008, 98015, 98012) based on review by technical experts, SMEs and/or public feedback. | Terminology | Annual Update |