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Measure: CMS154

Appropriate Treatment for Upper Respiratory Infection (URI)

Measure Versions

eMeasure Code Measure Year Full Version Number Title
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 dispensing event.

Guidance

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is a 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 PopulationOutpatient visits, telephone visits, online assessments, 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
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude URI episodes when the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had a new or refill prescription of antibiotics in the 30 days prior to or on the episode date. 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 overlapping with the measurement period.Webchart Instructions
NumeratorURI 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 infectionWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS154v9 2021 9.2.000 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 million antibiotic-resistant illnesses and 23,000 deaths occur each year, at a cost to the U.S. economy of at least $30 billion.

Clinical Recommendation Statement

American Family Physician (Fashner, Ericson, and Werner, Khilberg 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)

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 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 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 Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
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
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 Control and Prevention. (2018). Be antibiotics aware: Smart use, best care. Retrieved from https://www.cdc.gov/features/antibioticuse/
Fashner, J., Ericson, K., & Werner, S. (2012). Treatment of the common cold in children and adults. American Family Physician, 86(2), 153-159.
Harris, 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.

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) 2012-2019 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) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 copyright 2019 World Health Organization. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cmsv9