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Measure: CMS154

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS154v10 2022 10.1.000 Appropriate Treatment for Upper Respiratory Infection (URI)
CMS154v9 2021 9.2.000 Appropriate Treatment for Upper Respiratory Infection (URI)
CMS154v8 2020 8.1.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
CMS154v7 2019 7.2.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
CMS154v6 2018 6.1.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
CMS154v5 2017 5.1.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)

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

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 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 periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude 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.Webchart Instructions
NumeratorChildren without a prescription for antibiotic medication on or 3 days after the outpatient or ED visit for an upper respiratory infectionWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS154v6 154 2018 6.1.000 0069 e455fac0-f2cb-4074-a351-1e68a90fb7cf
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance National Quality Forum
Scoring Method Measure Type Stratification Risk Adjustment
Proportion PROCESS None None

Rate Aggregation

None

Improvement Notation

Higher scores indicates better quality

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)

Definition

None

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Diagnosis Competing Conditions for Respiratory Conditions 2.16.840.1.113883.3.464.1003.102.12.1017
Encounter, Performed Emergency Department Visit 2.16.840.1.113883.3.464.1003.101.12.1010
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed Face-to-Face Interaction 2.16.840.1.113883.3.464.1003.101.12.1048
Encounter, Performed Hospital Observation Care - Initial 2.16.840.1.113883.3.464.1003.101.12.1002
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Preventive Care - Established Office Visit, 0 to 17 2.16.840.1.113883.3.464.1003.101.12.1024
Encounter, Performed Preventive Care- Initial Office Visit, 0 to 17 2.16.840.1.113883.3.464.1003.101.12.1022
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
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

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.

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/cms154v6