| eCQM Title | Appropriate Treatment for Upper Respiratory Infection (URI) |
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|---|---|---|---|
| eCQM Identifier (Measure Authoring Tool) | 154 | eCQM Version Number | 12.0.000 |
| 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 order |
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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) 2012-2022 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) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 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 (Centers for Disease Control and Prevention [CDC], 2020). |
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| Clinical Recommendation Statement |
American Family Physician (Fashner, Ericson, and Werner, 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) Institute for Clinical Systems Improvement (Short, et al., 2017) The ICSI work group does not recommend antibiotics for treatment of common cold symptoms in children and adults. |
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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: JUSTIFICATION 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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| Reference |
Reference Type: CITATION Reference Text: 'Short S, Bashir H, Marshall P, Miller N, Olmschenk D, Prigge K, Solyntjes L. Institute for Clinical Systems Improvement. Diagnosis and Treatment of Respiratory Illness in Children and Adults. Updated September 2017. Retrieved from https://www.icsi.org/wp-content/uploads/2019/01/RespIllness.pdf.' |
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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. 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 from January 1 to December 28 of 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 visits, telephone visits, online assessments (i.e., e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI from January 1 to December 28 of the measurement period for 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 hospice care for any part of the measurement period. Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date. |
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| Numerator |
URI episodes without a prescription for antibiotic medication on or three 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 where AgeInMonthsAt(date from start of "Measurement Period")>= 3 return EncounterWithURI
"Initial Population"
"Encounters and Assessments with Hospice Patient" union "Encounter with Comorbid Condition for Upper Respiratory Infection Prior" union "Encounter with Upper Respiratory Infection and Antibiotics Active In 30 Days Prior to the Episode Date" union "Encounter with Competing Diagnosis for Upper Respiratory Infection"
"Encounter with Upper Respiratory Infection" EncounterWithURI
without ["Medication, Order": "Antibiotic Medications for Upper Respiratory Infection"] 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
where AgeInMonthsAt(date from start of "Measurement Period")>= 3
and AgeInYearsAt(date from start of "Measurement Period")<= 17
return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI where AgeInYearsAt(date from start of "Measurement Period")in Interval[18, 64] return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI where AgeInYearsAt(date from start of "Measurement Period")>= 65 return EncounterWithURI
"Initial Population"
"Encounters and Assessments with Hospice Patient" union "Encounter with Comorbid Condition for Upper Respiratory Infection Prior" union "Encounter with Upper Respiratory Infection and Antibiotics Active In 30 Days Prior to the Episode Date" union "Encounter with Competing Diagnosis for Upper Respiratory Infection"
( "Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Diagnosis": "Comorbid Conditions for Respiratory Conditions"] ComorbidCondition
such that start of ComorbidCondition.prevalencePeriod in day of 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 Encounters" QualifyingEncounters,
["Diagnosis": "Upper Respiratory Infection"] URI
where URI.prevalencePeriod starts during day of QualifyingEncounters.relevantPeriod
or URI.prevalencePeriod overlaps before QualifyingEncounters.relevantPeriod
return QualifyingEncounters
"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Medication, Active": "Antibiotic Medications for Upper Respiratory Infection"] ActiveAntibiotic
such that ( Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps day of Interval[start of EncounterWithURI.relevantPeriod - 30 days, start of EncounterWithURI.relevantPeriod - 1 day])
return EncounterWithURI
"Initial Population" InitialPopulation where Hospice."Has Hospice Services"
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 day of "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 day of "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 day of "Measurement Period"
)
or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
)
"Encounter with Upper Respiratory Infection" EncounterWithURI where AgeInMonthsAt(date from start of "Measurement Period")>= 3 return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI
without ["Medication, Order": "Antibiotic Medications for Upper Respiratory Infection"] OrderedAntibiotic
such that OrderedAntibiotic.authorDatetime 3 days or less on or after start of EncounterWithURI.relevantPeriod
return EncounterWithURI
( ["Encounter, Performed": "Emergency Department Evaluation and Management 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": "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": "Unlisted preventive medicine service"] ) ValidEncounters where ValidEncounters.relevantPeriod ends during day of Interval[start of "Measurement Period", end of "Measurement Period" - 3 days]
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
"Encounter with Upper Respiratory Infection" EncounterWithURI
where AgeInMonthsAt(date from start of "Measurement Period")>= 3
and AgeInYearsAt(date from start of "Measurement Period")<= 17
return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI where AgeInYearsAt(date from start of "Measurement Period")in Interval[18, 64] return EncounterWithURI
"Encounter with Upper Respiratory Infection" EncounterWithURI where AgeInYearsAt(date from start of "Measurement Period")>= 65 return EncounterWithURI
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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|---|---|---|---|