Quality Measure STU1 for FHIR STU3 Implementation Guide
This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v1.0.0: STU 1) based on FHIR R3. 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 xmlns="http://hl7.org/fhir"> <id value="measure-exm146-FHIR"/> <meta> <versionId value="3"/> <lastUpdated value="2019-11-06T18:22:32.201-05:00"/> <profile value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"/> </meta> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><table style="width: 60%; border-bottom: none;" class="header_table"> <!-- <tr th:if="${resource.hasId()}" style="vertical-align: top;"><th style="background-color:#656565; width:20%" scope="row"><span class="td_label">Id: </span></th><td style="width:80%" colspan="3" th:narrative="${resource.id}"></td></tr> --><tr style="vertical-align: top;"><td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Measure Title</span></td><td colspan="1" style="width:60%"><h1 style="font-size:10px">Appropriate Testing for Children with Pharyngitis</h1></td><td scope="row" style="background-color:#656565; width:10%"><span class="td_label">Measure ID</span></td><td colspan="1" style="width:10%"><h1 style="font-size:10px">EXM146</h1></td></tr> <!-- <th:block th:each="ident, iter : ${resource.identifier}"><tr th:if="${ident.type.coding[0].code == 'CMS'}" style="vertical-align: top;"><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">eCQM Identifier (Measure Authoring Tool)</span></td><td style="width:30%" th:narrative="${ident.value}"></td><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">eCQM Version number</span></td><td style="width:30%" th:narrative="${resource.version}"></td></tr></th:block><th:block th:each="ident, iter : ${resource.identifier}"><tr th:if="${ident.type.coding[0].code == 'NQF'}" style="vertical-align: top;"><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">NQF Number</span></td><td style="width:30%" th:narrative="${ident.value}"></td><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">GUID</span></td><td style="width:30%" th:narrative="${resource.url}"></td></tr></th:block> --><tr style="vertical-align: top;"><td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Description</span></td><td colspan="3" style="width:80%"><div style="width:660px;overflow-x:hidden;overflow-y:auto"><pre><p>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.</p> </pre> </div> </td> </tr> <tr> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Measurement Period</span></td> <td colspan="3" style="width:80%">January 1 - December 31</td> </tr> <!-- <tr> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Measure Steward</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.publisher}"></td> </tr> <tr> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Measure Developer</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.publisher}"></td> </tr> --> <!-- <tr th:if="${resource.hasDisclaimer()}"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Disclaimer</span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${resource.disclaimer}"></pre> </div> </td> </tr> --> <tr> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Copyright and Disclaimer Notice</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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].</pre> <br/> <pre>Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. (c) 2008 -2014 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 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.</pre> </div> </td> </tr> <tr> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Clinical Recommendation Statement</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"><p>Institute for Clinical Systems Improvement (ICSI) (2007)<br/> 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.<br/> Infectious Disease Society of America (Bisno et al. 2002)<br/> 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.<br/> 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.<br/> Michigan Quality Improvement Consortium (2007)<br/> 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)</p> </div> </td> </tr> <tr style="vertical-align: top;"> <td rowspan="4" scope="row" style="background-color:#656565; width:20%"><span class="td_label">References</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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.</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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.</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>Institute for Clinical Systems Improvement (ICSI). 2008. "Diagnosis and treatment of respiratory illness in children and adults." Bloomington: Institute for Clinical Systems Improvement (ICSI).</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>Michigan Quality Improvement Consortium. 2007. Acute pharyngitis in children. Southfield: Michigan Quality Improvement Consortium.</pre> </div> </td> </tr> <tr> <td colspan="4" scope="row" style="background-color:#656565; width:100%"><span class="td_label">Characteristics</span></td> </tr> <tr> <td scope="row" style="width:20%"><span>Scoring</span></td> <td colspan="3" style="width:80%">Proportion</td> </tr> <!-- <tr th:if="${resource.hasCompositeScoring()}"> <td style="width:20%" scope="row"><span class="td_label">Composite Scoring</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.compositeScoring.getText().substring(0, 1).toUpperCase() + resource.compositeScoring.getText().substring(1)}"></td> </tr> --> <tr style="vertical-align: top;"> <td rowspan="1" scope="row" style="width:20%"><span>Type</span></td> <td colspan="3" style="width:80%">Process</td> </tr> <!-- <tr th:if="${resource.hasStatus()}" style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Status</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.status.toString().substring(0, 1).toUpperCase() + resource.status.toString().substring(1).toLowerCase()}"></td> </tr> <tr th:if="${resource.hasPurpose()}" style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Purpose</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.purpose}"></td> </tr> <tr th:if="${resource.hasUsage()}" style="vertical-align: top;" > <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Usage</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.usage}"></td> </tr> <th:block th:each="context, iter : ${resource.useContext}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Use Context</span></td> <td style="width:80%" colspan="3" th:narrative="${context}"></td> </tr> </th:block> <th:block th:each="topics, iter : ${resource.topic}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Topic</span></td> <td style="width:80%" colspan="3" th:narrative="${topics}"></td> </tr> </th:block> <th:block th:each="cont, iter : ${resource.contributor}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Contributor</span></td> <td style="width:80%" colspan="3"> <b><span th:narrative="${cont.type.toCode()}"></span>: </b><span th:narrative="${cont.name}"></span> </td> </tr> </th:block> --> <!-- <th:block th:each="lib, iter : ${resource.library}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Library</span></td> <td style="width:80%" colspan="3"> <p th:if="${lib.hasIdentifier()}"><b>identifier: </b><span th:narrative="${lib.identifier}"></span></p> <p th:if="${lib.hasReference()}"><b>reference: </b><span th:narrative="${lib.reference}"></span></p> <p th:if="${lib.hasDisplay()}"><b>display: </b><span th:narrative="${lib.display}"></span></p> </td> </tr> </th:block> --> <!-- <tr th:if="${resource.hasRateAggregation()}" > <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Rate Aggregation</span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${resource.rateAggregation}"></pre> </div> </td> </tr> <tr th:if="${resource.hasRationale()}"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Rationale</span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${resource.rationale}"></pre> </div> </td> </tr> --> <tr> <td scope="row" style="width:20%"><span>Improvement Notation</span></td> <td colspan="3" style="width:80%">A higher rate indicates better performance.</td> </tr> <tr> <td scope="row" style="width:20%"><span>Guidance</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"><p>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.</p> </div> </td> </tr> <tr> <td colspan="4" scope="row" style="background-color:#656565; width:100%"><span class="td_label">Definitions</span></td> </tr> <!-- <th:block th:each="groups, iter : ${resource.uniquePopulationGroup}" > <tr style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label" th:text="${groups.identifier.value}"></span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${pops.description}"></pre> </div> </td> </tr> </th:block> --> </table> <table style="width: 60%; border-top: none; border-bottom: none" class="header_table"> </table> <table style="width: 60%; border-top: none;" class="header_table"> <!-- <th:block th:each="supples, iter : ${resource.supplementalData}"> <tr> <th th:if="${iter.index == 0}" th:rowspan="${iter.size}" scope="row"><b>Supplemental Data:</b></th> <td style="width:80%" colspan="3" > <p style="margin-bottom: 5px;" th:narrative="${supples.identifier}"></p> <p style="margin-bottom: 5px;" th:each="uses : ${supples.usage}"> <b>usage: </b> <span th:narrative="${uses}"></span> </p> <p style="margin-bottom: 5px;" th:if="${supples.hasCriteria()}"> <b>criteria: </b> <span th:narrative="${supples.criteria}"></span> </p> <p style="margin-bottom: 5px;" th:if="${supples.hasPath()}"> <b>path: </b> <span th:narrative="${supples.path}"></span> </p> </td> </tr> </th:block> --> <!-- <th:block th:each="param, iter : ${resource.parameter}"> <tr style="vertical-align: top;"> <th th:if="${iter.index == 0}" th:rowspan="${iter.size}" scope="row"><b>Parameter: </b></th> <td style="width:80%" colspan="3" > <span th:if="${param.hasName()}"> <b>name: </b> <span th:narrative="${param.name}"></span> <br/> </span> <b>use: </b> <span th:narrative="${param.use.toCode()}"></span> <br/> <span th:if="${param.hasMin()}"> <b>minimum cardinality: </b> <span th:narrative="${param.min}"></span> <br/> </span> <span th:if="${param.hasMax()}"> <b>maximum cardinality: </b> <span th:narrative="${param.max}"></span> <br/> </span> <b>type: </b> <span th:narrative="${param.type}"></span> <br/> <span th:if="${param.hasDocumentation()}"> <b>documentation: </b> <span th:narrative="${param.documentation}"></span> <br/> </span> <span th:if="${param.hasProfile()}"> <b>profile: </b> <span th:narrative="${param.profile}"></span> <br/> </span> <p style="margin-bottom: 5px;"></p> </td> </tr> </th:block> --> <!-- <th:block th:each="dataReq, iter : ${resource.dataRequirement}"> <tr style="vertical-align: top;"> <th th:if="${iter.index == 0}" th:rowspan="${iter.size}" scope="row" ><b>Data Requirements: </b></th> <td style="width:80%" colspan="3" th:narrative="${dataReq}"></td> </tr> </th:block> --> </table> <h2><a name="toc">Table of Contents</a></h2> <ul style="padding-left: 50px;"> <li><a href="#d1e405">Population Criteria</a></li> <li><a href="#d1e649">Definitions</a></li> <li><a href="#d1e650">Functions</a></li> <li><a href="#d1e555">Terminology</a></li> <li><a href="#d1e647">Data Criteria (QDM Data Elements)</a></li> <li><a href="#d1e767">Supplemental Data Elements</a></li> <li><a href="#d1e879">Risk Adjustment Variables</a></li> </ul> <div style="float:left; background:teal; height:3px; width:80%"/> <pre><br/></pre> <h3><a name="d1e405" href="#toc">Population Criteria</a></h3> <div> <ul style="list-style:none;padding-left:10px;"> <li style="list-style:none;padding-left:0px;" class="list-unstyled"> <div class="treeview hover p-l-10"> <ul class="list-unstyled"> <li class="list-unstyled"><input id="Initial Population" type="checkbox"/><label for="Initial Population" class="list-header"><strong>Initial Population</strong></label> <ul class="code"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul> <li style="padding-left: 0px;"> <div> <pre class="cql-definition-body"> "Pharyngitis Encounters With Antibiotics"</pre> </div></li> </ul> </div></li> </ul></li> </ul> </div> <div class="treeview hover p-l-10"> <ul class="list-unstyled"> <li class="list-unstyled"><input id="Numerator" type="checkbox"/><label for="Numerator" class="list-header"><strong>Numerator</strong></label> <ul class="code"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul> <li style="padding-left: 0px;"> <div> <pre class="cql-definition-body"> "Strep Test Encounters"</pre> </div></li> </ul> </div></li> </ul></li> </ul> </div> <div class="treeview hover p-l-10"> </div> <div class="treeview hover p-l-10"> </div> </li> </ul> </div> <h3><a name="d1e649" href="#toc">Definitions</a></h3> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Antibiotics" type="checkbox"/> <label for="Antibiotics" class="list-header"><strong>Antibiotics</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> [MedicationRequest: medication in "Antibiotic Medications"] Prescription where Prescription.status = 'active' and Prescription.intent = 'order'</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Denominator Exclusions" type="checkbox"/> <label for="Denominator Exclusions" class="list-header"><strong>Denominator Exclusions</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> "Excluded Encounters"</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Excluded Encounters" type="checkbox"/> <label for="Excluded Encounters" class="list-header"><strong>Excluded Encounters</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> "Pharyngitis Encounters With Antibiotics" Encounters with "Pharyngitis With Prior Antibiotics" Pharyngitis such that Common."Includes Or Starts During"(Pharyngitis, Encounters)</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Initial Population" type="checkbox"/> <label for="Initial Population" class="list-header"><strong>Initial Population</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> "Pharyngitis Encounters With Antibiotics"</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Is Between 2 and 17 Years of Age at Start of Measurement Period" type="checkbox"/> <label for="Is Between 2 and 17 Years of Age at Start of Measurement Period" class="list-header"><strong>Is Between 2 and 17 Years of Age at Start of Measurement Period</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> AgeInYearsAt(start of "Measurement Period") >= 2 and AgeInYearsAt(start of "Measurement Period") <= 17</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Measurement Period Encounters" type="checkbox"/> <label for="Measurement Period Encounters" class="list-header"><strong>Measurement Period Encounters</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> [Encounter: "Ambulatory/ED Visit"] Encounter where Encounter.period during "Measurement Period" and Encounter.status = 'finished' and "Is Between 2 and 17 Years of Age at Start of Measurement Period"</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Numerator" type="checkbox"/> <label for="Numerator" class="list-header"><strong>Numerator</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> "Strep Test Encounters"</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Pharyngitis" type="checkbox"/> <label for="Pharyngitis" class="list-header"><strong>Pharyngitis</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> ([Condition: code in "Acute Pharyngitis"] union [Condition: code in "Acute Tonsillitis"]) Pharyngitis where Pharyngitis.clinicalStatus = 'active' and Pharyngitis.verificationStatus = 'confirmed'</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Pharyngitis Encounters With Antibiotics" type="checkbox"/> <label for="Pharyngitis Encounters With Antibiotics" class="list-header"><strong>Pharyngitis Encounters With Antibiotics</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> "Measurement Period Encounters" Encounters with "Pharyngitis" Pharyngitis such that Common."Includes Or Starts During"(Pharyngitis, Encounters) with "Antibiotics" Antibiotics such that Antibiotics.authoredOn 3 days or less after FHIRHelpers.ToInterval(Encounters.period)</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Pharyngitis With Prior Antibiotics" type="checkbox"/> <label for="Pharyngitis With Prior Antibiotics" class="list-header"><strong>Pharyngitis With Prior Antibiotics</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> "Pharyngitis" Pharyngitis with "Antibiotics" Antibiotics such that Antibiotics.authoredOn 30 days or less before Pharyngitis.onset</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <input id="Strep Test Encounters" type="checkbox"/> <label for="Strep Test Encounters" class="list-header"><strong>Strep Test Encounters</strong></label> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body"> "Pharyngitis Encounters With Antibiotics" Encounters with [Observation: code in "Group A Streptococcus Test"] Tests such that Tests.value is not null and Tests.effective starts during Interval[start of FHIRHelpers.ToInterval(Encounters.period) - 3 days, end of FHIRHelpers.ToInterval(Encounters.period) + 3 days]</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <h3><a name="d1e650" href="#toc">Functions</a></h3> <h3><a name="d1e555" href="#toc">Terminology</a></h3> <div> <ul style="padding-left: 50px;"> <li style="width:80%">valueset "Acute Pharyngitis" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011'</li> <li style="width:80%">valueset "Acute Tonsillitis" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012'</li> <li style="width:80%">valueset "Ambulatory/ED Visit" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061'</li> <li style="width:80%">valueset "Antibiotic Medications" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001'</li> <li style="width:80%">valueset "Group A Streptococcus Test" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012'</li> </ul> </div> <h3><a name="d1e647" href="#toc">Data Criteria (QDM Data Elements)</a></h3> <div> <ul style="padding-left: 50px;"> <li style="width:80%">"Condition: Acute Pharyngitis" using "Acute Pharyngitis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011)</li> <li style="width:80%">"Condition: Acute Tonsillitis" using "Acute Tonsillitis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012)</li> <li style="width:80%">"Encounter: Ambulatory/ED Visit" using "Ambulatory/ED Visit (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061)</li> <li style="width:80%">"MedicationRequest: Antibiotic Medications" using "Antibiotic Medications (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001)</li> <li style="width:80%">"Observation: Group A Streptococcus Test" using "Group A Streptococcus Test (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012)</li> </ul> </div> <h3><a name="d1e767" href="#toc">Supplemental Data Elements</a></h3> <div> <ul style="list-style:none;padding-left: 25px;"> <li>None</li> </ul> </div> <h3><a name="d1e879" href="#toc">Risk Adjustment Variables</a></h3> <div> <ul style="list-style:none;padding-left: 25px;"> <li>None</li> </ul> </div> <div style="float:left; background:teal; height:3px; width:80%"/> <table> <!-- <th:block th:each="con, iter : ${resource.content}"> <tr th:if="${con.contentType == 'text/cql'}" style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Content</span></td> <td style="width:80%" ><b>type: </b><span th:text="${con.contentType}"></span></td> </tr> <tr th:if="${con.contentType == 'text/cql'}"> <td style="width:100%" colspan="2" > <th:block th:if="${con.getData() != null }" > <pre><code th:class="${con.contentType == 'text/cql' ? 'language-cql' : 'language-xml'}" th:text="${new java.lang.String(con.getData())}"></code></pre> </th:block> <th:block th:if="${con.getData() == null }" > <span><i><content is empty></i></span> </th:block> </td> </tr> </th:block > --> </table> </div> </text> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis"> <valueCode value="Encounter"/> </extension> <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm146-FHIR"/> <identifier> <use value="official"/> <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"/> <value value="146"/> </identifier> <version value="1.0.0"/> <name value="EXM146"/> <title value="Appropriate Testing for Children with Pharyngitis"/> <status value="active"/> <experimental value="true"/> <date value="2019-02-21T00:00:00-05:00"/> <publisher value="National Committee for Quality Assurance"/> <description value="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."/> <purpose value="Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005)."/> <approvalDate value="2016-01-01"/> <lastReviewDate value="2016-09-01"/> <effectivePeriod> <start value="2018-01-01T00:00:00-05:00"/> <end value="2018-12-31T00:00:00-05:00"/> </effectivePeriod> <useContext> <code> <code value="program"/> </code> <valueCodeableConcept> <text value="eligible-provider"/> </valueCodeableConcept> </useContext> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> <display value="United States of America"/> </coding> </jurisdiction> <contributor> <type value="author"/> <name value="National Committee for Quality Assurance"/> </contributor> <contact> <telecom> <system value="url"/> <value value="http://www.ncqa.org/"/> </telecom> </contact> <copyright value="Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. (c) 2008 -2014 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 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."/> <relatedArtifact> <type value="citation"/> <citation value="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."/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="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."/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Institute for Clinical Systems Improvement (ICSI). 2008. "Diagnosis and treatment of respiratory illness in children and adults." Bloomington: Institute for Clinical Systems Improvement (ICSI)."/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Michigan Quality Improvement Consortium. 2007. Acute pharyngitis in children. Southfield: Michigan Quality Improvement Consortium."/> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource> <reference value="Library/fhirhelpers"/> </resource> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource> <reference value="Library/common-fhir"/> </resource> </relatedArtifact> <library> <reference value="Library/exm146-fhir"/> </library> <disclaimer value="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]."/> <scoring> <coding> <system value="http://hl7.org/fhir/measure-scoring"/> <code value="proportion"/> </coding> </scoring> <type> <coding> <system value="http://hl7.org/fhir/measure-type"/> <code value="process"/> </coding> </type> <rationale value="Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005)."/> <clinicalRecommendationStatement value="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)"/> <improvementNotation value="increase"/> <guidance value="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."/> <group> <identifier> <value value="group-1"/> </identifier> <population> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="initial-population"/> <display value="Initial Population"/> </coding> </code> <criteria value="Initial Population"/> </population> <population> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="numerator"/> <display value="Numerator"/> </coding> </code> <criteria value="Numerator"/> </population> <population> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator"/> <display value="Denominator"/> </coding> </code> <criteria value="Denominator"/> </population> <population> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator-exclusion"/> <display value="Denominator Exclusion"/> </coding> </code> <criteria value="Denominator Exclusion"/> </population> </group> </Measure>
© HL7.org (Clinical Quality Information WG). hl7.fhir.us.cqfmeasures#1.0.0 based on FHIR v3.0.2 generated 20/11/2019.
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