Measure: CMS146
Appropriate Testing for Children with Pharyngitis
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| CMS146v12 |
2024 |
12.0.000 |
Appropriate Testing for Pharyngitis |
| CMS146v11 |
2023 |
11 |
Appropriate Testing for Pharyngitis |
| CMS146v10 |
2022 |
10.1.000 |
Appropriate Testing for Pharyngitis |
| 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 Population | Children 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 visit | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis.
Exclude patients whose hospice care overlaps the measurement period.
Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of pharyngitis | Webchart Instructions |
| Numerator | Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS146v8 |
146 |
2020 |
8.2.000 |
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 (Shulman et al., 2012 ). 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 "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 |
| Diagnosis |
Competing Conditions for Respiratory Conditions |
2.16.840.1.113883.3.464.1003.102.12.1017 |
| Encounter, Performed |
Discharge Services- Observation Care |
2.16.840.1.113883.3.464.1003.101.12.1039 |
| 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 |
Home Healthcare Services |
2.16.840.1.113883.3.464.1003.101.12.1016 |
| Encounter, Performed |
Hospital Observation Care - Initial |
2.16.840.1.113883.3.464.1003.101.12.1002 |
| Encounter, Performed |
Medical Disability Exam |
2.16.840.1.113883.3.464.1003.101.11.1233 |
| Encounter, Performed |
Office Visit |
2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed |
Outpatient Consultation |
2.16.840.1.113883.3.464.1003.101.12.1008 |
| 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 Services - Established Office Visit, 18 and Up |
2.16.840.1.113883.3.464.1003.101.12.1025 |
| Encounter, Performed |
Preventive Care Services - Group Counseling |
2.16.840.1.113883.3.464.1003.101.12.1027 |
| Encounter, Performed |
Preventive Care Services - Other |
2.16.840.1.113883.3.464.1003.101.12.1030 |
| Encounter, Performed |
Preventive Care Services-Individual Counseling |
2.16.840.1.113883.3.464.1003.101.12.1026 |
| Encounter, Performed |
Preventive Care Services-Initial Office Visit, 18 and Up |
2.16.840.1.113883.3.464.1003.101.12.1023 |
| 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 |
| 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., Bates, D. W., Lee, G. M., et al. (2005). Antibiotic treatment of children with sore throat. JAMA, 294(18), 2315-2322.
Roberts, R. R., Hota, B., Ahmad, I., et al. (2009, October). Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: Implications for antibiotic stewardship. Clinical Infectious Diseases, 49(8), 1175-1184.
Shulman , S. T., Bisno, A. L., Clegg, H. W., et al. (2012, November 15). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), E86-E102. doi:10.1093/cid/cis629
Disclaimer
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Source:
https://ecqi.healthit.gov/ecqm/measures/cms146v8