eCQM Title

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

eCQM Identifier (Measure Authoring Tool) 154 eCQM Version number 8.1.000
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
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 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) 2012-2019 National Committee for Quality Assurance. All Rights Reserved. 

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CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 World Health Organization. All Rights Reserved
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Measure Scoring Proportion
Measure Type Process
Risk Adjustment
Rate Aggregation
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 million antibiotic-resistant illnesses and 23,000 deaths occur each year, at a cost to the U.S. economy of at least $30 billion.
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)
Improvement Notation
Higher scores indicates better quality
Centers for Disease Control and Prevention. (2013). "Be antibiotics aware: Smart use, best care." retrieved from 
Fashner, J., Ericson, K., & Werner, S. (2012). Treatment of the common cold in children and adults. American Family Physician, 86(2), 153-159. 
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.
Hersh, A. L.,  Shapiro, D. J., Pavia, A. T., et al. (2011). "Antibiotic prescribing in ambulatory pediatrics in the United States." Pediatrics 128(6), :1053-1061. 
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 visit with a diagnosis of URI during the measurement period
Equals Initial Population
Denominator Exclusions
Exclude children who are taking antibiotics in the 30 days prior to 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 whose hospice care overlaps the measurement period.
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 Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set