| eCQM Title | Appropriate Testing for Pharyngitis |
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|---|---|---|---|
| eCQM Identifier (Measure Authoring Tool) | 146 | eCQM Version Number | 11.1.000 |
| NQF Number | Not Applicable | GUID | beb1c33c-2549-4e7f-9567-05ed38448464 |
| Measurement Period | January 1, 20XX through December 31, 20XX | ||
| Measure Steward | National Committee for Quality Assurance | ||
| Measure Developer | National Committee for Quality Assurance | ||
| Endorsed By | None | ||
| Description |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date |
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| Copyright |
This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2021 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2021 American Medical Association. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved. |
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| Disclaimer |
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. |
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| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification |
• 3-17 years • 18-64 years • 65 years and older |
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| Risk Adjustment |
None |
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| Rate Aggregation |
None |
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| Rationale |
Group A streptococcal (GAS) bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (Shulman et al., 2012). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al., 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance varies but has extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Pfoh et al., 2008). |
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| Clinical Recommendation Statement |
Infectious Disease Society of America (2012) The Infectious Diseases Society of America "recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present" |
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| Improvement Notation |
Higher score indicates better quality |
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| Reference |
Reference Type: CITATION Reference Text: 'Linder, J. A., Bates, D. W., Lee, G. M., et al. (2005). Antibiotic Treatment of Children with Sore Throat. JAMA, 294(18), 2315-2322.' |
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| Reference |
Reference Type: CITATION Reference Text: 'Pfoh, E., Wessels, M.R., Goldmann, D., et al. (2008). Burden and Economic Cost of Group A Streptococcal Pharyngitis. Pediatrics, 121(2), 229-234. doi: 10.1542/peds.2007-0484' |
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| Reference |
Reference Type: CITATION Reference Text: 'Shulman, S. T., Bisno, A. L., Clegg, H. W., et al. (2012). Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), E86-E102. doi:10.1093/cid/cis629' |
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| Definition |
None |
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| 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 ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on the episode date through 3 days after the episode date. 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 order during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
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| Transmission Format |
TBD |
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| 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 or tonsillitis and an antibiotic order on or within 3 days after the episode date among patients 3 years or older |
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| Denominator |
Equals Initial Population |
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| 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. |
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| Numerator |
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 |
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| Numerator Exclusions |
Not Applicable |
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| Denominator Exceptions |
None |
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| Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
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"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")>= 3 return EncounterWithPharyngitis
"Initial Population"
"In Hospice" union "Encounter With Antibiotic Active In 30 Days Prior Or The First Day of the Encounter" union "Encounter With Competing Diagnosis for Upper Respiratory Infection" union "Encounter With Comorbid Condition Prior"
from
"Group A Streptococcus Lab Test With Result" GroupAStreptococcusTest,
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
where ( Global."NormalizeInterval" ( GroupAStreptococcusTest.relevantDatetime, GroupAStreptococcusTest.relevantPeriod ) starts during day of Interval[(
end of EncounterWithPharyngitis.relevantPeriod
) - 3 days, (
end of EncounterWithPharyngitis.relevantPeriod
) + 3 days]
)
return EncounterWithPharyngitis
None
None
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")in Interval[3, 17] return EncounterWithPharyngitis
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")in Interval[18, 64] return EncounterWithPharyngitis
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")>= 65 return EncounterWithPharyngitis
"Initial Population"
"In Hospice" union "Encounter With Antibiotic Active In 30 Days Prior Or The First Day of the Encounter" union "Encounter With Competing Diagnosis for Upper Respiratory Infection" union "Encounter With Comorbid Condition Prior"
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic
such that ( Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps day of Interval[start of EncounterWithPharyngitis.relevantPeriod - 30 days, start of EncounterWithPharyngitis.relevantPeriod - 1 day])
return EncounterWithPharyngitis
"Qualifying Encounters" EDOrAmbulatoryVisit
with ["Medication, Order": "Antibiotic Medications for Pharyngitis"] AntibioticOrdered
such that ( start of EDOrAmbulatoryVisit.relevantPeriod ) 3 days or less on or before day of AntibioticOrdered.authorDatetime
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
with ["Diagnosis": "Comorbid Conditions for Respiratory Conditions"] ComorbidCondition
such that start of ComorbidCondition.prevalencePeriod in day of Interval[start of EncounterWithPharyngitis.relevantPeriod - 1 year, start of EncounterWithPharyngitis.relevantPeriod]
return EncounterWithPharyngitis
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
with ["Diagnosis": "Competing Conditions for Respiratory Conditions"] CompetingCondition
such that CompetingCondition.prevalencePeriod starts 3 days or less on or after day of start of EncounterWithPharyngitis.relevantPeriod
return EncounterWithPharyngitis
from "Encounter With Antibiotic Ordered Within Three Days" VisitWithAntibiotic, "Pharyngitis or Tonsillitis" AcutePharyngitisTonsillitis where AcutePharyngitisTonsillitis.prevalencePeriod starts during day of VisitWithAntibiotic.relevantPeriod return VisitWithAntibiotic
["Laboratory Test, Performed": "Group A Streptococcus Test"] GroupAStreptococcusTest where GroupAStreptococcusTest.result is not null
exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
)
or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
where HospiceEncounter.relevantPeriod overlaps "Measurement Period"
)
or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
where HospiceAssessment.result ~ "Yes (qualifier value)"
and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod ) overlaps "Measurement Period"
)
or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
where HospiceOrder.authorDatetime during day of "Measurement Period"
)
or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps "Measurement Period"
)
"Initial Population" EligibleEncounters where Hospice."Has Hospice Services"
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")>= 3 return EncounterWithPharyngitis
from
"Group A Streptococcus Lab Test With Result" GroupAStreptococcusTest,
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
where ( Global."NormalizeInterval" ( GroupAStreptococcusTest.relevantDatetime, GroupAStreptococcusTest.relevantPeriod ) starts during day of Interval[(
end of EncounterWithPharyngitis.relevantPeriod
) - 3 days, (
end of EncounterWithPharyngitis.relevantPeriod
) + 3 days]
)
return EncounterWithPharyngitis
( ["Diagnosis": "Acute Pharyngitis"]
union ["Diagnosis": "Acute Tonsillitis"]
)
( ["Encounter, Performed": "Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital observation status if the discharge is on other than the initial date of observation status. To report services to a patient designated as observation status or inpatient status and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])"] union ["Encounter, Performed": "Emergency Department Visit"] union ["Encounter, Performed": "Home Healthcare Services"] union ["Encounter, Performed": "Initial Hospital Observation Care"] union ["Encounter, Performed": "Medical Disability Exam"] union ["Encounter, Performed": "Observation"] union ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Telephone Visits"] union ["Encounter, Performed": "Online Assessments"] union ["Encounter, Performed": "Outpatient Consultation"] union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"] union ["Encounter, Performed": "Preventive Care Services Group Counseling"] union ["Encounter, Performed": "Unlisted preventive medicine service"] union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] union ["Encounter, Performed": "Preventive Care Services Individual Counseling"] union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"] union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"] ) ValidEncounters where ValidEncounters.relevantPeriod during day of "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")in Interval[3, 17] return EncounterWithPharyngitis
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")in Interval[18, 64] return EncounterWithPharyngitis
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis where AgeInYearsAt(date from start of "Measurement Period")>= 65 return EncounterWithPharyngitis
if pointInTime is not null then Interval[pointInTime, pointInTime] else if period is not null then period else null as Interval<DateTime>
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
| Measure Set |
None |
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|---|---|---|---|