| eCQM Title | Appropriate Treatment for Upper Respiratory Infection (URI) |
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|---|---|---|---|
| eCQM Identifier (Measure Authoring Tool) | 154 | eCQM Version Number | 10.1.000 |
| NQF Number | Not Applicable | GUID | e455fac0-f2cb-4074-a351-1e68a90fb7cf |
| 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 |
Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event. |
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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) 2012-2020 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 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 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 months-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 |
Most URI, also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often, antibiotics are prescribed inappropriately, which can lead to antibiotic resistance (when antibiotics can no longer cure bacterial infections). In the United States, at least 2.8 million antibiotic-resistant illnesses and 35,000 deaths occur each year. |
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| Clinical Recommendation Statement |
American Family Physician (Fashner, Ericson, and Werner, Khilberg 2012) - Antibiotics should not be used for the treatment of cold symptoms in children or adults. (A) - Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. (A) - Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults. (B) |
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| Improvement Notation |
Higher score indicates better quality |
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| Reference |
Reference Type: CITATION Reference Text: 'Centers for Disease Control and Prevention. (2020). Be antibiotics aware: Smart use, best care. Retrieved from https://www.cdc.gov/patientsafety/features/be-antibiotics-aware.html' |
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| Reference |
Reference Type: CITATION Reference Text: 'Fashner, J., Ericson, K., & Werner, S. (2012). Treatment of the common cold in children and adults. American Family Physician, 86(2), 153-159.' |
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| Reference |
Reference Type: CITATION Reference Text: 'Harris, A.M., Hicks, L.A., Qaseem, A. (2016.) "Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and The Centers for Disease Control and Prevention." Ann Intern Med. 164(6):425-434.' |
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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. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period. This version of the eCQM uses QDM version 5.5. 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 visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older. |
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| Denominator |
Equals Initial Population |
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| Denominator Exclusions |
Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, including the episode date up until the time of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period. |
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| Numerator |
URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection |
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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 Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3
return EncounterWithURI
"Initial Population"
"In Hospice" union "Encounter with Upper Respiratory Infection and Antibiotics Active 30 Days Prior" union "Encounter with Competing Diagnosis for Upper Respiratory Infection" union "Encounter with Comorbid Condition for Upper Respiratory Infection Prior"
"Encounter with Upper Respiratory Infection" EncounterWithURI
without ["Medication, Order": "Antibiotic Medications for Pharyngitis"] OrderedAntibiotic
such that OrderedAntibiotic.authorDatetime 3 days or less on or after start of EncounterWithURI.relevantPeriod
return EncounterWithURI
None
None
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3
and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 17
return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 64]
return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
return EncounterWithURI
"Initial Population"
"In Hospice" union "Encounter with Upper Respiratory Infection and Antibiotics Active 30 Days Prior" union "Encounter with Competing Diagnosis for Upper Respiratory Infection" union "Encounter with Comorbid Condition for Upper Respiratory Infection Prior"
( "Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Diagnosis": "Comorbid Conditions for Respiratory Conditions"] ComorbidCondition
such that start of ComorbidCondition.prevalencePeriod in Interval[start of EncounterWithURI.relevantPeriod - 1 year, start of EncounterWithURI.relevantPeriod]
return EncounterWithURI
)
( "Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Diagnosis": "Competing Conditions for Respiratory Conditions"] CompetingCondition
such that CompetingCondition.prevalencePeriod starts 3 days or less on or after day of start of EncounterWithURI.relevantPeriod
return EncounterWithURI
)
from
"Qualifying Encounter" QualifyingEncounter,
["Diagnosis": "Upper Respiratory Infection"] URI
where URI.prevalencePeriod starts during QualifyingEncounter.relevantPeriod
or URI.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod
return QualifyingEncounter
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic
such that Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps Interval[Global."ToDate" ( ( start of EncounterWithURI.relevantPeriod ) - 30 days ), start of EncounterWithURI.relevantPeriod]
return EncounterWithURI
exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice
where ( DischargeHospice.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or DischargeHospice.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and DischargeHospice.relevantPeriod ends during "Measurement Period"
)
or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder
where HospiceOrder.authorDatetime during "Measurement Period"
)
or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed
where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps "Measurement Period"
)
"Initial Population" InitialPopulation where Hospice."Has Hospice"
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3
return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI
without ["Medication, Order": "Antibiotic Medications for Pharyngitis"] OrderedAntibiotic
such that OrderedAntibiotic.authorDatetime 3 days or less on or after start of EncounterWithURI.relevantPeriod
return EncounterWithURI
( ["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": "Hospital Observation Care - Initial"] union ["Encounter, Performed": "Medical Disability Exam"] union ["Encounter, Performed": "Observation"] union ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Outpatient Consultation"] union ["Encounter, Performed": "Preventive Care Services - Group Counseling"] union ["Encounter, Performed": "Preventive Care Services-Individual Counseling"] union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"] union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"] union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"] union ["Encounter, Performed": "Telephone Visits"] union ["Encounter, Performed": "Online Assessments"] union ["Encounter, Performed": "Preventive Care Services - Other"] ) ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 3
and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 17
return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 64]
return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
return EncounterWithURI
months between ToDate(BirthDateTime)and ToDate(AsOf)
years between ToDate(BirthDateTime)and ToDate(AsOf)
if pointInTime is not null then Interval[pointInTime, pointInTime] else if period is not null then period else null as Interval<DateTime>
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
["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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|---|---|---|---|