eMeasure Title

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

eMeasure Identifier (Measure Authoring Tool) 154 eMeasure Version number 6.1.000
NQF Number 0069 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 National Quality Forum
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
This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, 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 must be approved by NCQA and are subject to a license at the discretion of 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. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. 

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Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Office Visit
Measure Item Count
Encounter, Performed: Emergency Department Visit
Measure Item Count
Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17
Measure Item Count
Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17
Measure Item Count
Encounter, Performed: Hospital Observation Care - Initial
Measure Item Count
Encounter, Performed: Face-to-Face Interaction
Risk Adjustment
Rate Aggregation
Most upper respiratory infections (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). Pediatric ambulatory visits to physicians account for nearly 50 million antibiotic prescriptions annually in the U.S. The total economic impact of treating URIs is close to $17 billion per year in direct costs.
Clinical Recommendation Statement
American Family Physician (Wong, Blumberg, and Lowe 2006) 

- A diagnosis of acute bacterial rhinosinusitis should be considered in patients with symptoms of a viral upper respiratory infection that have not improved after 10 days or that worsen after five to seven days. (C) 

- Treatment of sinus infection with antibiotics in the first week of symptoms is not recommended. (C)

- Telling patients not to fill an antibiotic prescription unless symptoms worsen or fail to improve after several days can reduce the inappropriate use of antibiotics. (B)
Improvement Notation
Higher scores indicates better quality
Centers for Disease Prevention and Control. 2013. "Antibiotics Aren't Always the Answer." http://www.cdc.gov/features/getsmart/ 
Hersh A.L., D.J. Shapiro, A.T. Pavia, S.S. Shah. 2011. "Antibiotic prescribing in ambulatory pediatrics in the United States." Pediatrics 128(6):1053-61. 
Fendrick, M.A., A.S. Monto, B. Nightengale, M. Sarnes. 2003. "The Economic Burden of Non-Influenza-Related Viral Respiratory Tract Infection in the United States." Archives of Internal Medicine 163(4):487-94.
Wong, D.M., D.A. Blumberg, and L.G. Lowe. 2006. "Guidelines for the use of antibiotics in acute upper respiratory tract infections." Am Fam Physician 74(6):956-966.
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.
Transmission Format
Initial 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
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.

Exclude patients who were in hospice care during the measurement year.
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
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents

Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set