This measure is used to assess the percentage of children 2 to 18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic, and received a group A streptococcus (strep) test for the episode.

Pharyngitis is the only condition among upper respiratory infections (URIs) whose diagnosis is easily and objectively validated through administrative and laboratory data, and it can serve as an important indicator of appropriate antibiotic use among all respiratory tract infections. Overuse of antibiotics has been directly linked to the prevalence of antibiotic resistance in the community; promoting judicious use of antibiotics is important to reducing levels of antibiotic resistance. Pediatric clinical practice guidelines recommend that only children with diagnosed group A streptococcus (strep) pharyngitis, based on appropriate lab tests, be treated with antibiotics. A strep test (rapid assay or throat culture) is the definitive test of group A strep pharyngitis. Excess use of antibiotics is highly prevalent for pharyngitis; about 35 percent of the total 9 million antibiotics prescribed for pharyngitis in 1998 were estimated to be in excess.

Pharyngitis; antibiotics; group A streptococcus (strep) test; children

Children 2 years of age as of July 1 of the year prior to the measurement year to 18 years of age as of June 30 of the measurement year, with a Negative Medication History, who had an outpatient or emergency department (ED) visit with only a diagnosis of pharyngitis and a dispensed antibiotic for that episode of care during the Intake Period (see the related "Denominator Inclusions/Exclusions" field)

Children from the denominator with a group A streptococcus (strep) test (refer to Table CWP-D in the original measure documentation for codes to identify group A strep tests) in the seven-day period from three days prior to the Index Episode Start Date (IESD) through three days after the IESD (see the related "Numerator Inclusions/Exclusions" field)

Unspecified

Age 2 to 18 years

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

Inclusions
Children 2 years of age as of July 1 of the year prior to the measurement year to 18 years of age as of June 30 of the measurement year, with Negative Medication History, who had an outpatient or emergency department (ED) visit with only a diagnosis of pharyngitis and a dispensed antibiotic for that episode of care during the Intake Period

Note:

• Children must have been continuously enrolled 30 days prior to the Episode Date through 3 days after the Episode Date (inclusive) with no gaps in enrollment during the continuous enrollment period.
• Episode Date: The date of service for any outpatient or ED visit (refer to Table CWP-B in the original measure documentation for codes to identify visit type) during the Intake Period with only a diagnosis of pharyngitis (refer to Table CWP-A in the original measure documentation for codes to identify pharyngitis).
• Negative Medication History: To qualify for Negative Medication History, the following criteria must be met:
  • A period of 30 days prior to the Episode Date, when the member had no pharmacy claims for either new or refill prescriptions for a listed antibiotic drug
  • No prescriptions filled more than 30 days prior to the Episode Date that are active on the Episode Date (refer to Table CWP-C in the original measure documentation for antibiotic medications)
• A prescription is considered active if the "days supply" indicated on the date the member filled the prescription is the number of days or more between that date and the relevant service date. The 30-day look back period for pharmacy data includes the 30 days prior to the Intake Period.
• 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 is used to capture eligible episodes of treatment.

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

Exclusions

• Exclude claims/encounters with more than one diagnosis.
• Do not include ED visits that result in an inpatient admission.
• Exclude Episode Dates if the member did not receive antibiotics on or three days after the Episode Date.
• Test for Negative Medication History. Exclude Episode Dates where a new or refill prescription for an antibiotic medication was filled 30 days prior to the Episode Date or where a prescription filled more than 30 days prior to the Episode Date was active on the Episode Date.

Inclusions
Children from the denominator with a group A streptococcus (strep) test (refer to Table CWP-D in the original measure documentation for codes to identify group A strep tests) in the seven-day period from three days prior to the Index Episode Start Date (IESD) through three days after the IESD*

*IESD: The earliest Episode Date during the Intake Period that meets all of the following criteria:

• Linked to a dispensed antibiotic prescription on or during the three days after the Episode Date
• A 30-day Negative Medication History prior to the Episode Date
• The member was continuously enrolled during the 30 days prior to the Episode Date through 3 days after the Episode Date

Exclusions
Unspecified

Unspecified

This measure requires that separate rates be reported for Medicaid and commercial product lines.

Appropriate testing for children with pharyngitis (CWP).

Unspecified

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.

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.

2009 Aug 10

This measure was not adapted from another source.

Unspecified

Unspecified

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

The individual measure, "Appropriate Testing for Children with Pharyngitis (CWP)," is published in "HEDIS® 2012. Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications for Health Plans."

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .

The following is available:

• National Committee for Quality Assurance (NCQA). The state of health care quality 2011. Continuous improvement and the expansion of quality measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. 199 p.

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .

This NQMC summary was completed by ECRI on June 16, 2006. The information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on November 15, 2007. The information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on March 10, 2009. The information was verified by the measure developer on May 29, 2009. This NQMC summary was updated again by ECRI Institute on January 15, 2010 and February 16, 2011. This NQMC summary was retrofitted into the new template on June 29, 2011. This NQMC summary was updated again by ECRI Institute on May 16, 2012.

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

For detailed specifications regarding the National Committee on Quality Assurance (NCQA) measures, refer to HEDIS Volume 2: Technical Specifications for Health Plans, available from the NCQA Web site at www.ncqa.org .