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  • Measure Summary
  • NQMC:009937
  • Nov 2014
  • NQF-Endorsed Measure

Appropriate treatment for children with upper respiratory infection (URI): percentage of children 3 months to 18 years of age who were given a diagnosis of URI and were not treated with an antibiotic medication.

National Committee for Quality Assurance (NCQA). HEDIS 2015 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

This is the current release of the measure.

This measure updates a previous version: National Committee for Quality Assurance (NCQA). HEDIS 2013 Technical Specifications for ACO Measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2012. various p.

The measure developer reaffirmed the currency of this measure in November 2015.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of children 3 months to 18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not treated with an antibiotic medication.

This measure is reported as an inverted rate [1 - (numerator/eligible population)]. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion that did not receive antibiotics).

Note from the National Quality Measures Clearinghouse (NQMC): For this measure, there are both Electronic and Hybrid Specifications. This NQMC measure summary is based on the Electronic specification. Refer to the original measure documentation for details pertaining to the Hybrid specification.

Rationale

The common cold (or upper respiratory infection [URI]) is a frequent reason for children visiting the doctor's office. Though existing clinical guidelines do not support the use of antibiotics for the common cold, physicians often prescribe them for this ailment (Rosenstein et al., 1998). Pediatric clinical practice guidelines (Rosenstein et al., 1998) do not recommend antibiotics for a majority of upper respiratory tract infections because of the viral etiology of these infections, including the common cold. A performance measure of antibiotic use for URI sheds light on the prevalence of inappropriate antibiotic prescribing in clinical practice and raises awareness of the importance of reducing inappropriate antibiotic use to combat antibiotic resistance in the community.

Evidence for Rationale

National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Rosenstein N, Phillips WR, Gerber MA, Marcy SM, Schwartz B, Dowell SF, et al. The common cold--principles of judicious use of antimicrobial agents. Pediatrics. 1998;101(Suppl):181-4.

Primary Health Components

Upper respiratory infection (URI); antibiotic treatment; children

Denominator Description

Children age 3 months as of July 1 of the year prior to the measurement year to 18 years as of June 30 of the measurement year, with a Negative Medication History and a Negative Competing Diagnosis, who had an outpatient or emergency department (ED) visit with only a diagnosis of respiratory infection (URI) during the Intake Period (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Evidence of antibiotic medication dispensed or prescribed on or three days after the Index Episode Start Date (IESD) (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

All HEDIS measures undergo systematic assessment of face validity with review by measurement advisory panels, expert panels, a formal public comment process and approval by the National Committee for Quality Assurance's (NCQA) Committee on Performance Measurement and Board of Directors. Once NCQA establishes national benchmarks for accountable care organization (ACO) performance, all measures will undergo formal reliability testing of the performance measure score using beta-binomiol statistical analysis. Where applicable, measures also are assessed for construct validity using the Pearson correlation test.

Evidence for Extent of Measure Testing

Rehm B. (Assistant Vice President, Performance Measurement, National Committee for Quality Assurance, Washington, DC). Personal communication. 2015 Apr 8.  1 p.

State of Use

Current routine use

Current Use

Accreditation

Collaborative inter-organizational quality improvement

Decision-making by consumers about health plan/provider choice

Decision-making by health plans about provider contracting

Internal quality improvement

Pay-for-performance

Public reporting

Measurement Setting

Accountable Care Organizations

Ambulatory/Office-based Care

Emergency Department

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Multisite Health Care or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age 3 months to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

A 12-month window that begins on July 1 of the year prior to the measurement year and ends on June 30 of the measurement year

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window brackets index event

Denominator Inclusions/Exclusions

Inclusions
Children age 3 months as of July 1 of the year prior to the measurement year to 18 years as of June 30 of the measurement year, with a Negative Medication History and a Negative Competing Diagnosis, who had an outpatient visit (Outpatient Value Set), an observation visit (Observation Value Set) or an emergency department (ED) visit (ED Value Set) during the Intake Period, with only a diagnosis of upper respiratory infection (URI) (URI Value Set)

Note:

  • Intake Period: A 12-month window that begins on July 1 of the year prior to the measurement year and ends on June 30 of the measurement year. The Intake Period captures eligible episodes of treatment.
  • Episode Date: The date of service for any outpatient or ED visit during the Intake Period with only a diagnosis of URI.
  • Negative Medication History: A period of 30 days prior to the Episode Date when the patient had no antibiotic treatment. The 30-day look-back period for pharmacy and prescription data includes the 30 days prior to the Intake Period.
    • Pharmacy Data: No prescriptions filled more than 30 days prior to the Episode Date that are active on the Episode Date. A prescription is considered active if the "days supply" indicated on the date when the patient filled the prescription is the number of days or more between that date and the relevant service date.
    • Prescription Data: No prescriptions more than 30 days prior to the Episode Date that are active on the Episode Date. A prescription is considered active if the total "days supply" including refills on the prescription date is the number of days or more between the prescription date and the relevant service date.
  • Negative Competing Diagnosis: The Episode Date and three days following the Episode Date during which the patient had no visits with any competing diagnosis.

Refer to the original measure documentation for steps to identify the eligible population.

Exclusions

  • Exclude claims/encounters with more than one diagnosis code.
  • Exclude ED visits that result in an inpatient admission.
  • Test for Negative Medication History. Exclude Episode Dates with evidence of antibiotic medication (refer to Table ACWP-C in the original measure documentation for a list of antibiotic medications) 30 days prior to the Episode Date.
  • Test for Negative Competing Diagnosis. Exclude Episode Dates where the patient had a claim/encounter with a competing diagnosis on or three days after the Episode Date. A code from either of the following meets criteria for a competing diagnosis:
    • Pharyngitis Value Set
    • Competing Diagnosis Value Set

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS 2015 Technical Specifications for ACO Measurement, which includes the Value Set Directory.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Evidence of antibiotic medication on or three days after the Index Episode Start Date (IESD). Refer to Table ACWP-C in the original measure documentation for a list of antibiotic medications.

  • Pharmacy Data: Dispensed antibiotic medication
  • Prescription Data: Prescribed antibiotic medication

Note:

  • IESD: The earliest Episode Date during the Intake Period that meets all of the following criteria:
    • A 30-day Negative Medication History prior to the Episode Date
    • A Negative Competing Diagnosis during the 3 days after the Episode Date
  • This measure is reported as an inverted rate [1 - (numerator/eligible population)].

Exclusions
Unspecified

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS 2015 Technical Specifications for ACO Measurement, which includes the Value Set Directory.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Pharmacy data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

Description of Allowance for Patient or Population Factors

The Accountable Care Organization (ACO) aggregate population is reported as a whole, with an option to report Medicaid separately for measures for which HEDIS Health Plan Measurement offers Medicaid specifications.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Appropriate treatment for children with upper respiratory infection (AURI).

Measure Collection Name

HEDIS 2015: Accountable Care Organization (ACO) Collection

Measure Set Name

Effectiveness of Care

Measure Subset Name

Respiratory Conditions

Submitter

National Committee for Quality Assurance - Health Care Accreditation Organization

Developer

National Committee for Quality Assurance - Health Care Accreditation Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

Financial Disclosures/Other Potential Conflicts of Interest

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

Endorser

National Quality Forum

NQF Number

0069

Date of Endorsement

2016 Mar 3

Adaptation

This measure was adapted from the HEDIS Technical Specifications for Health Plans ("HEDIS Health Plan Measurement") and HEDIS Physician Measurement.

Date of Most Current Version in NQMC

2014 Nov

Measure Maintenance

Annual

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: National Committee for Quality Assurance (NCQA). HEDIS 2013 Technical Specifications for ACO Measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2012. various p.

The measure developer reaffirmed the currency of this measure in November 2015.

Source(s)

National Committee for Quality Assurance (NCQA). HEDIS 2015 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Measure Availability

Source available for purchase from the National Committee for Quality Measurement (NCQA) Web site External Web Site Policy.

For more information, contact NCQA at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 13, 2014.

This NQMC summary was updated by ECRI Institute on February 11, 2015.

The information was reaffirmed by the measure developer on November 2, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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