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
This is an episode of care measure that examines all eligible episodes for the patient.
This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection from January 1 to December 28 of the measurement period.
This version of the eCQM uses QDM version 5.6. 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 visits, telephone visits, online assessments (i.e., e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI from January 1 to December 28 of the measurement period for patients 3 months of age and older | Webchart Instructions |
Denominator | Equals Initial Population | Webchart Instructions |
Denominator Exclusions | Exclude URI episodes when the patient had hospice care for any part of the measurement period.
Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.
Exclude URI episodes where the patient is taking antibiotics in the 30 days prior to the episode date.
Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date. | Webchart Instructions |
Numerator | URI episodes without a prescription for antibiotic medication on or three 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 |
CMS154v12 |
|
2024 |
12.0.000 |
Not Applicable |
e455fac0-f2cb-4074-a351-1e68a90fb7cf |
Steward |
Developer |
Endorsed By |
National Committee for Quality Assurance |
National Committee for Quality Assurance |
|
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 quality
Rationale
Most 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). In the United States, at least 2.8 million antibiotic-resistant illnesses and 35,000 deaths occur each year (Centers for Disease Control and Prevention [CDC], 2020).
Clinical Recommendation Statement
American Family Physician (Fashner, Ericson, and Werner, 2012)
- Antibiotics should not be used for the treatment of cold symptoms in children or adults. (A)
- Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. (A)
- Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults. (B)
Institute for Clinical Systems Improvement (Short, et al., 2017)
The ICSI work group does not recommend antibiotics for treatment of common cold symptoms in children and adults.
Definition
None
Transmission Format
TBD
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 |
Hospice Diagnosis |
2.16.840.1.113883.3.464.1003.1165 |
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 Upper Respiratory Infection |
2.16.840.1.113883.3.464.1003.1190 |
Medication, Order |
Antibiotic Medications for Upper Respiratory Infection |
2.16.840.1.113883.3.464.1003.1190 |
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
CITATIONCenters for Disease Control and Prevention. (2020). Be Antibiotics Aware: Smart Use, Best Care. Retrieved from https://www.cdc.gov/patientsafety/features/be-antibiotics-aware.html
CITATIONFashner, J., Ericson, K., & Werner, S. (2012). Treatment of the Common Cold in Children and Adults. American Family Physician, 86(2), 153-159.
JUSTIFICATIONHarris, A.M., Hicks, L.A., Qaseem, A. (2016.) "Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care from the American College of Physicians and the Centers for Disease Control and Prevention." Ann Intern Med. 164(6),425-434.
CITATIONShort S, Bashir H, Marshall P, Miller N, Olmschenk D, Prigge K, Solyntjes L. Institute for Clinical Systems Improvement. Diagnosis and Treatment of Respiratory Illness in Children and Adults. Updated September 2017. Retrieved from https://www.icsi.org/wp-content/uploads/2019/01/RespIllness.pdf.
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 are owned and were developed by the National Committee for Quality Assurance (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. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., 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 or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 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 third-party codes contained in the specifications.
CPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc.
This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation.
ICD-10 copyright 2022 World Health Organization. All Rights Reserved.
Source:
https://ecqi.healthit.gov/ecqm/measures/cmsv1