Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Last updated: May 3, 2018

CMS Measure ID: CMS154v6
Version: 6
NQF Number: 0069
Measure Description:

Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode

Initial Patient Population:

Children age 3 months to 18 years who had an outpatient or emergency department (ED) visit with a diagnosis of upper respiratory infection (URI) during the measurement period

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Exclude children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established. Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of URI.

Exclude patients who were in hospice care during the measurement year.

Numerator Statement:

Children without a prescription for antibiotic medication on or 3 days after the outpatient or ED visit for an upper respiratory infection

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Efficiency and Cost Reduction
Next Version:
Previous Version:
Improvement Notation:

Higher scores 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.

Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • ​Updated the exclusion statement in the header to exclude patients in hospice care from the Denominator. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Changed timing operator for URI diagnosis in Initial Population from 'ends after or concurrent with end of' to 'overlaps' to ensure inclusion of patients without an end date for their diagnosis.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Added a new line of logic to the Denominator Exclusions that requires the medication to be active at least one day prior to diagnosis of pharyngitis or tonsillitis to better meet the intent of the measure.

    Measure Section: Denominator Exclusions

    Source of Change: JIRA (CQM-496)

  • Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.

    Measure Section: Denominator Exclusions

    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 Upper Respiratory Infection (2.16.840.1.113883.3.464.1003.102.12.1022): Deleted 4 ICD9CM codes (460, 465.0, 465.8, 465.9).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 53 RXNORM codes and deleted 7 RXNORM codes (105152, 105170, 313251, 351239, 636559, 762666, 900424).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Deleted 457 ICD9CM codes. Added 119 SNOMEDCT codes and deleted 194 SNOMEDCT codes. Added 251 ICD10CM codes and deleted 252 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207): Added Discharged to Health Care Facility for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209): Added Discharged to Home for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 88 RXNORM codes and deleted 18 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Added 18 SNOMEDCT codes and deleted 3 SNOMEDCT codes (195667003, 65127006, 236704009). Added 2 ICD10CM codes (A04.71, A04.72).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources