Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Last updated: May 17, 2016

CMS Measure ID: CMS154v4
Version: 4
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
National Quality Strategy Domain: Efficiency and Cost Reduction Use of Healthcare Resources
Next Version: Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Previous Version: Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Measure Score: Proportion
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.

Specifications

Release Notes

Header

  • eMeasure version number incremented.
  • Disclaimer updated.
  • Copyright updated.

Logic

  • Changed the antibiotic medications for pharyngitis before the occurrence A of the encounter from starts before the end of to starts before the start of so as not to exclude patients who receive antibiotics at the URI encounter.
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.
  • Introduced variable $URIEncounter to allow re-use of logical expressions and reduce redundancy/complexity .

Value Sets

  • Value set Competing Conditions for Respiratory Conditions (OID 2.16.840.1.113883.3.464.1003.102.12.1017): Added 24 SNOMED codes; deleted 11 SNOMED codes.
  • Value set Antibiotic Medications for Pharyngitis (OID 2.16.840.1.113883.3.464.1003.196.12.10): Deleted 9 RXNORM codes (1113012, 240637, 240639, 312127, 312128, 312130, 476193, 476299, 597194).

External Resources