Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Last updated: June 9, 2017

CMS Measure ID: CMS154v5
Version: 5
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.

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: Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Previous Version: Appropriate Treatment for Children with Upper Respiratory Infection (URI)
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.

Addendum Notes: ICD-10 Value Set addition
Quality ID: 65
High Priority Measure: Yes
Data Submission Method: EHR,Registry
Specialty Measure Set: General Practice/Family Medicine,Pediatrics

Specifications

Release Notes

Header

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

Logic

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Denominator Exclusions

    Source: QDM Standards

  • Updated the Denominator Exclusion to ensure patients on antibiotics for more than 30 days prior to the Occurrence A Diagnosis are excluded.

    Section: Denominator Exclusions

    Source: JIRA (CQM-1570)

  • Updated the Initial Population logic to clarify which events are eligible for the Initial Population.

    Section: Initial Population

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

Value Set

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Deleted 73 RXNORM codes.

    Section: None

    Source: None

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Deleted 6 SNOMEDCT codes (186841000, 286882004, 371308001, 403481005, 72643006, 95572004). Added 4 SNOMEDCT codes (197172005, 236683007, 237043008, 237106009). Added 1 ICD10CM code (J02.8).

    Section: None

    Source: None

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Added 1 ICD10CM code (L03.213).

    Section: None

    Source: ICD-10 Addendum

External Resources