eMeasure Title

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

eMeasure Identifier (Measure Authoring Tool) 154 eMeasure Version number 5.1.000
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
Description
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
Copyright
Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 

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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 CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 World Health Organization. All Rights Reserved.
Disclaimer
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

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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
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
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
Reference
Centers for Disease Prevention and Control. 2013. "Antibiotics Aren't Always the Answer." http://www.cdc.gov/features/getsmart/ 
Reference
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. 
Reference
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.
Reference
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.
Definition
None
Guidance
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
TBD
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
Denominator
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.
Numerator
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
None
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
None