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 dispensed an antibiotic prescription on or three days after the Index Episode Start Date (IESD).

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

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. Pediatric clinical practice guidelines 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.

Upper respiratory infection (URI); antibiotic treatment; children

Children 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 upper respiratory infection (URI) during the Intake Period (see the related "Denominator Inclusions/Exclusions" field)

Children from the denominator who were dispensed prescription for antibiotic medication (refer to Table CWP-C in the original measure documentation for a list of antibiotic medications) on or three days after the Index Episode Start Date (IESD) (see the related "Numerator Inclusions/Exclusions" field)

Unspecified

Age 3 months 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 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 Negative Competing Diagnosis, who had an outpatient or emergency department (ED) visit with only a diagnosis of upper respiratory infection (URI) 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 emergency department (ED) visit (refer to Table URI-B in the original measure documentation for codes to identify visit type) during the Intake Period with only a diagnosis of upper respiratory infection (URI) (refer to Table URI-A in the original measure documentation for codes to identify URI).
• 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, during which time 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 a list of antibiotic medications)
• A prescription is considered active if the "days supply" indicated on the date when 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.
• Negative Competing Diagnosis: The Episode Date and three days following the Episode Date, when the member had no claims/encounters with any competing diagnosis (refer to Table URI-C in the original measure documentation for codes to identify competing diagnoses).
• 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.

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.
• 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 was active on the Episode Date (refer to Table CWP-C in the original measure documentation for a list of antibiotic medications).
• Test for Negative Competing Diagnosis. Exclude Episode Dates where the member had a claim/encounter with a competing diagnosis (refer to Table URI-C in the original measure documentation for codes to identify competing diagnosis) on or 3 days after the Episode Date.

Inclusions
Children from the denominator who were dispensed prescription for antibiotic medication (refer to Table CWP-C in the original measure documentation for a list of antibiotic medications) on or three days after the Index Episode Start Date (IESD)*

Note: This measure is reported as an inverted rate [1 - (numerator/eligible population)]. A higher rate indicates appropriate treatment of children with URI (i.e., proportion for whom antibiotics were not prescribed).

*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
• The member was continuously enrolled 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 treatment for children with upper respiratory infection (URI).

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 Treatment for Children with Upper Respiratory Infection (URI)," 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 April 11, 2005. The information was verified by the measure developer on December 15, 2005. 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 30, 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 .