Measure: CMS154
Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| CMS154v12 |
2024 |
12.0.000 |
Appropriate Treatment for Upper Respiratory Infection (URI) |
| CMS154v11 |
2023 |
11 |
Appropriate Treatment for Upper Respiratory Infection (URI) |
| 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 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 | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| 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. | Webchart Instructions |
| Numerator | Children without a prescription for antibiotic medication on or 3 days after the outpatient or ED visit for an upper respiratory infection | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
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.
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Copyright
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Source:
https://ecqi.healthit.gov/ecqm/measures/cms154v6