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Appropriate Testing for Children with Pharyngitis

Last updated: May 9, 2019

CMS Measure ID: CMS146v8
Version: 8
NQF Number: Not Applicable
Measure Description:

Percentage of children 3-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode

Initial Patient Population:

Children 3-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit

Denominator Statement:

Equals Initial Populationinfo-icon

Denominator Exclusions:

Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis.

Exclude patients whose hospice care overlaps the measurement period.

Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of pharyngitis

Numerator Statement:

Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Efficiency and Cost Reduction
Previous Version:
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. If the patient has more than one episode, include all episodes in the measure.

Quality ID: 066
Meaningful Measure: Appropriate Use of Healthcare

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Added denominator exclusionsinfo-icon statement for competing diagnosis at the same encounter as the pharyngitis diagnosis or in the 3 days after the pharyngitis diagnosis to ensure the patient did not have another diagnosis for which it was appropriate to prescribe an antibiotic.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Added the define statement 'Competing Diagnosis for Upper Respiratory Infection' to ensure the patient did not have another diagnosis for which it was appropriate to prescribe an antibiotic.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Added the definition 'Qualifying Encounter' to provide more transparency into the encounters that qualify for the initial populationinfo-icon.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Hospice Library (Hospice-2.0.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set Acute Tonsillitis (2.16.840.1.113883.3.464.1003.102.12.1012): Added 1 SNOMED CT code (10629231000119109).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Deleted 3 RxNorm codes (1801142, 310156, 877486).

    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 Competing Conditions for Respiratory Conditions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Discharge Services- Observation Care (2.16.840.1.113883.3.464.1003.101.12.1039): Added Discharge Services- Observation Care.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Emergency Department Visit (2.16.840.1.113883.3.464.1003.101.12.1010): Added Emergency Department Visit.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Hospital Observation Care - Initial (2.16.840.1.113883.3.464.1003.101.12.1002): Added Hospital Observation Care - Initial.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Medical Disability Exam (2.16.840.1.113883.3.464.1003.101.11.1233): Added Medical Disability Exam.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Added Outpatient Consultation.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025): Added Preventive Care Services - Established Office Visit, 18 and Up.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Preventive Care Services - Group Counseling (2.16.840.1.113883.3.464.1003.101.12.1027): Added Preventive Care Services - Group Counseling.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030): Added Preventive Care Services - Other.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Preventive Care Services-Individual Counseling (2.16.840.1.113883.3.464.1003.101.12.1026): Added Preventive Care Services-Individual Counseling.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023): Added Preventive Care Services-Initial Office Visit, 18 and Up.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Added Home Healthcare Services.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added Office Visit.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022): Added Preventive Care Services, Initial Office Visit, 0 to 17.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024): Added Preventive Care, Established Office Visit, 0 to 17.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Ambulatory/ED Visit (2.16.840.1.113883.3.464.1003.101.12.1061): Removed Ambulatory/ED Visit and added value sets for encounters to be more transparent on what encounters were applicable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

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