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Measure: CMS146

Appropriate Testing for Children with Pharyngitis

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS146v9 2021 9.2.000 Appropriate Testing for Pharyngitis
CMS146v8 2020 8.2.000 Appropriate Testing for Children with Pharyngitis
CMS146v7 2019 7.2.000 Appropriate Testing for Children with Pharyngitis
CMS146v6 2018 6.1.000 Appropriate Testing for Children with Pharyngitis
CMS146v5 2017 5.1.000 Appropriate Testing for Children with Pharyngitis

Description

Percentage of children 3-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode

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.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationChildren 3-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visitWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsChildren who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis. Exclude patients who were in hospice care during the measurement year.Webchart Instructions
NumeratorChildren with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitisWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS146v6 146 2018 6.1.000 Not Applicable beb1c33c-2549-4e7f-9567-05ed38448464
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance
Scoring Method Measure Type Stratification Risk Adjustment
Proportion PROCESS None None

Rate Aggregation

None

Improvement Notation

Higher score indicates better quality

Rationale

Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance vary but have extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Roberts et al. 2009).

Clinical Recommendation Statement

Infectious Disease Society of America (2012) 

The Infectious Diseases Society of America (IDSA) "recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present"

Definition

None

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Diagnosis Acute Pharyngitis 2.16.840.1.113883.3.464.1003.102.12.1011
Diagnosis Acute Tonsillitis 2.16.840.1.113883.3.464.1003.102.12.1012
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Intervention, Order Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Laboratory Test, Performed Group A Streptococcus Test 2.16.840.1.113883.3.464.1003.198.12.1012
Medication, Active Antibiotic Medications for Pharyngitis 2.16.840.1.113883.3.464.1003.196.12.1001
Medication, Order Antibiotic Medications for Pharyngitis 2.16.840.1.113883.3.464.1003.196.12.1001
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1

References

Linder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. "Antibiotic treatment of children with sore throat." JAMA 294(18):2315-2322.
Infectious Diseases Society of America. 2012. "Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update."
Roberts, R.R., B. Hota, I. Ahmad, et al. "Hospital and Societal Costs of Antimicrobial-Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship." Clin Infect Dis. Oct 2009; 49(8):1175-84.

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].

Copyright

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. 

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 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved.

The American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact [email protected]

Source: https://ecqi.healthit.gov/ecqm/measures/cms146v6