Measure: CMS146
Appropriate Testing for 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
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test
Guidance
This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.
This eCQM is an episode-based measure.
This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | Outpatient, telephone, online assessment, observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event among patients 3 years or older | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date.
Exclude episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date.
Exclude episodes when the patient had hospice care overlapping with the measurement period.
Exclude episodes where the patient had a competing diagnosis within three days after the episode date. | Webchart Instructions |
| Numerator | A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS146v9 |
146 |
2021 |
9.2.000 |
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 |
• 3-17 years
• 18-64 years
• 65 years and older |
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 varies but has 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) (Pfoh et al, 2008).
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 |
Comorbid Conditions for Respiratory Conditions |
2.16.840.1.113883.3.464.1003.102.12.1025 |
| 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 |
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 |
| Encounter, Performed |
Telephone Visits |
2.16.840.1.113883.3.464.1003.101.12.1080 |
| 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.
Pfoh, E., Wessels, M.R., Goldmann, D., et al. (2008). Burden and economic cost of group A streptococcal pharyngitis. Pediatrics, 121(2), 229-234. doi: 10.1542/peds.2007-0484
Shulman, S. T., Bisno, A. L., Clegg, H. W., et al. (2012). 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/cms146v9