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Appropriate Testing for Pharyngitis

General eCQM Information

CMS Measure ID CMS146v10
NQF Number Not Applicable
Measure 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

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
Denominator Statement

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.

Numerator Statement

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

Denominator Exceptions

None

Measure Steward National Committee for Quality Assurance
Domain Efficiency and Cost Reduction
Measure Scoring Proportion
Measure Type Process
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. 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 (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Quality ID 66
Meaningful Measure Appropriate Use of Healthcare
Telehealth Eligible Yes
Previous Version

Release Notes

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

Last Updated: Jul 08, 2021