Measure: CMS154
Appropriate Treatment for 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 episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order.Guidance
Patient Group Definitions
| Group | Description | Instructions Links |
|---|---|---|
| Initial Population | Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date but is still active the same day of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period. | Webchart Instructions |
| Numerator | URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department 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 |
|---|---|---|---|---|---|
| CMS154v11 | 154 | 2023 | 11 | 0069 | e455fac0-f2cb-4074-a351-1e68a90fb7cf |
| Steward | Developer | Endorsed By |
|---|---|---|
| National Committee for Quality Assurance | National Committee for Quality Assurance | None |
| Scoring Method | Measure Type | Stratification | Risk Adjustment |
|---|---|---|---|
| Proportion | Process | 3 months-17 years 18-64 years 65 years and older | None |
Rate Aggregation
None
Improvement Notation
Higher score indicates better qualityRationale
Clinical Recommendation Statement
Definition
Transmission Format
Applicable Value Sets
| Category | Value Set | OID |
|---|---|---|
| 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 |
| Diagnosis | Upper Respiratory Infection | 2.16.840.1.113883.3.464.1003.102.12.1022 |
| 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 | Hospice Encounter | 2.16.840.1.113883.3.464.1003.1003 |
| Encounter, Performed | Hospital Observation Care - Initial | 2.16.840.1.113883.3.464.1003.101.12.1002 |
| Encounter, Performed | Medical Disability Exam | 2.16.840.1.113883.3.464.1003.101.12.1073 |
| Encounter, Performed | Observation | 2.16.840.1.113883.3.464.1003.101.12.1086 |
| Encounter, Performed | Office Visit | 2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed | Online Assessments | 2.16.840.1.113883.3.464.1003.101.12.1089 |
| 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-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 | 2.16.840.1.113883.3.526.3.1584 |
| Intervention, Performed | Hospice Care Ambulatory | 2.16.840.1.113883.3.526.3.1584 |
| 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 |