Table of Contents


Population Criteria

        • "Encounter With Pharyngitis or Tonsillitis" EncounterWithPharyngitis
            with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
              such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3
            return EncounterWithPharyngitis.VisitWithAntibiotic
         
        • "Initial Population"
         
        • "In Hospice"
            union "Encounter With Antibiotic Active In 30 Days Prior"
            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" EncounterWithPharyngitis
            where ( GroupAStreptococcusTest.relevantDatetime 3 days or less on or before day of 
              end of EncounterWithPharyngitis.VisitWithAntibiotic.relevantPeriod
                or GroupAStreptococcusTest.relevantDatetime 3 days or less on or after day of 
                end of EncounterWithPharyngitis.VisitWithAntibiotic.relevantPeriod
            )
            return EncounterWithPharyngitis.VisitWithAntibiotic
         
        • None
         
        • None
         
        • "Encounter With Pharyngitis or Tonsillitis" EncounterWithPharyngitis
            with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
              such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[3, 17]
            return EncounterWithPharyngitis.VisitWithAntibiotic
         
        • "Encounter With Pharyngitis or Tonsillitis" EncounterWithPharyngitis
            with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
              such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 64]
            return EncounterWithPharyngitis.VisitWithAntibiotic
         
        • "Encounter With Pharyngitis or Tonsillitis" EncounterWithPharyngitis
            with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
              such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
            return EncounterWithPharyngitis.VisitWithAntibiotic
         
  • Definitions

    Functions

    Terminology

    • code "Birth date" ("LOINC Code (21112-8)")
    • code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
    • code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
    • code "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.])" ("CPT Code (99217)")
    • valueset "Acute Pharyngitis" (2.16.840.1.113883.3.464.1003.102.12.1011)
    • valueset "Acute Tonsillitis" (2.16.840.1.113883.3.464.1003.102.12.1012)
    • valueset "Antibiotic Medications for Pharyngitis" (2.16.840.1.113883.3.464.1003.196.12.1001)
    • valueset "Comorbid Conditions for Respiratory Conditions" (2.16.840.1.113883.3.464.1003.102.12.1025)
    • valueset "Competing Conditions for Respiratory Conditions" (2.16.840.1.113883.3.464.1003.102.12.1017)
    • valueset "Emergency Department Visit" (2.16.840.1.113883.3.464.1003.101.12.1010)
    • valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
    • valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
    • valueset "Group A Streptococcus Test" (2.16.840.1.113883.3.464.1003.198.12.1012)
    • valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
    • valueset "Hospice care ambulatory" (2.16.840.1.113762.1.4.1108.15)
    • valueset "Hospital Observation Care - Initial" (2.16.840.1.113883.3.464.1003.101.12.1002)
    • valueset "Medical Disability Exam" (2.16.840.1.113883.3.464.1003.101.11.1233)
    • valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
    • valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
    • valueset "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008)
    • valueset "Payer" (2.16.840.1.114222.4.11.3591)
    • valueset "Preventive Care Services - Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
    • valueset "Preventive Care Services - Group Counseling" (2.16.840.1.113883.3.464.1003.101.12.1027)
    • valueset "Preventive Care Services - Other" (2.16.840.1.113883.3.464.1003.101.12.1030)
    • valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
    • valueset "Preventive Care Services-Individual Counseling" (2.16.840.1.113883.3.464.1003.101.12.1026)
    • valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
    • valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
    • valueset "Race" (2.16.840.1.114222.4.11.836)
    • valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)

    Data Criteria (QDM Data Elements)

    • "Diagnosis: Acute Pharyngitis" using "Acute Pharyngitis (2.16.840.1.113883.3.464.1003.102.12.1011)"
    • "Diagnosis: Acute Tonsillitis" using "Acute Tonsillitis (2.16.840.1.113883.3.464.1003.102.12.1012)"
    • "Diagnosis: Comorbid Conditions for Respiratory Conditions" using "Comorbid Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1025)"
    • "Diagnosis: Competing Conditions for Respiratory Conditions" using "Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017)"
    • "Encounter, Performed: Emergency Department Visit" using "Emergency Department Visit (2.16.840.1.113883.3.464.1003.101.12.1010)"
    • "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
    • "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
    • "Encounter, Performed: Hospital Observation Care - Initial" using "Hospital Observation Care - Initial (2.16.840.1.113883.3.464.1003.101.12.1002)"
    • "Encounter, Performed: Medical Disability Exam" using "Medical Disability Exam (2.16.840.1.113883.3.464.1003.101.11.1233)"
    • "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.])" using "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.]) (CPT Code 99217)"
    • "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
    • "Encounter, Performed: Outpatient Consultation" using "Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008)"
    • "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
    • "Encounter, Performed: Preventive Care Services - Group Counseling" using "Preventive Care Services - Group Counseling (2.16.840.1.113883.3.464.1003.101.12.1027)"
    • "Encounter, Performed: Preventive Care Services - Other" using "Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030)"
    • "Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
    • "Encounter, Performed: Preventive Care Services-Individual Counseling" using "Preventive Care Services-Individual Counseling (2.16.840.1.113883.3.464.1003.101.12.1026)"
    • "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
    • "Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
    • "Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
    • "Intervention, Order: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
    • "Intervention, Performed: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
    • "Laboratory Test, Performed: Group A Streptococcus Test" using "Group A Streptococcus Test (2.16.840.1.113883.3.464.1003.198.12.1012)"
    • "Medication, Active: Antibiotic Medications for Pharyngitis" using "Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001)"
    • "Medication, Order: Antibiotic Medications for Pharyngitis" using "Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001)"
    • "Patient Characteristic Birthdate: Birth date" using "Birth date (LOINC Code 21112-8)"
    • "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
    • "Patient Characteristic Payer: Payer" using "Payer (2.16.840.1.114222.4.11.3591)"
    • "Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
    • "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"

    Supplemental Data Elements

    Risk Adjustment Variables