Quality Measure STU2 for FHIR R4 Implementation Guide

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v1.1.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

Measure-measure-exm146-FHIR

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Measure Title

Appropriate Testing for Children with Pharyngitis

Measure ID

EXM146

Description

Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.

Measurement Period January 1 - December 31
Copyright and Disclaimer Notice
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. 
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Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 
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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 CPT or other codes contained in the specifications.
CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.
Clinical Recommendation Statement

Institute for Clinical Systems Improvement (ICSI) (2007)
Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically.
Infectious Disease Society of America (Bisno et al. 2002)
The signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx.
With the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis.
Michigan Quality Improvement Consortium (2007)
Probability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)

References
Linder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. “Antibiotic treatment of children with sore throat.” JAMA 294(18):2315-2322.
Bisno, A.L., M.A. Gerber, J.M. Gwaltney Jr., E.L. Kaplan, R.H. Schwartz, Infectious Diseases Society of America. 2002. “Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America.” Clin Infect Dis 35(2):113-25.
Institute for Clinical Systems Improvement (ICSI). 2008. "Diagnosis and treatment of respiratory illness in children and adults." Bloomington: Institute for Clinical Systems Improvement (ICSI).
Michigan Quality Improvement Consortium. 2007. Acute pharyngitis in children. Southfield: Michigan Quality Improvement Consortium.
Characteristics
Scoring Proportion
Type Process
Improvement Notation A higher rate indicates better performance.
Guidance

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.

Definitions

Table of Contents


Population Criteria

        • org.hl7.fhir.r4.model.Expression@30eb1b67
         
        • org.hl7.fhir.r4.model.Expression@3911caf5
         
        • org.hl7.fhir.r4.model.Expression@be6c58f
         
        • org.hl7.fhir.r4.model.Expression@3cf0d3d0
         

Definitions

        • org.hl7.fhir.r4.model.Expression@5428d70a
         
        • org.hl7.fhir.r4.model.Expression@63d9f918
         
        • org.hl7.fhir.r4.model.Expression@5e2e9251
         
        • org.hl7.fhir.r4.model.Expression@647ab417
         
        • org.hl7.fhir.r4.model.Expression@76f8bf15
         
        • org.hl7.fhir.r4.model.Expression@5ac589eb
         
        • org.hl7.fhir.r4.model.Expression@70d334f8
         
        • org.hl7.fhir.r4.model.Expression@4138ecf9
         
        • org.hl7.fhir.r4.model.Expression@720bf3dc
         
        • org.hl7.fhir.r4.model.Expression@477a6a7
         
        • org.hl7.fhir.r4.model.Expression@6dea3625
         

Functions

Supplemental Data Elements

  • None

Risk Adjustment Variables

  • None