Quality Measure Implementation Guide (STU3 Ballot)
2.1.0 - ballot

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v2.1.0: STU3 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

Example Measure: Appropriate Testing for Children with Pharyngitis

Id: measure-exm146-FHIR
Url: http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm146-FHIR
Version: 4.0.0
Identifier:

value: 146

Name: EXM146
Title: Appropriate Testing for Children with Pharyngitis
Status: active
Experimental: true
Scoring:

system: http://terminology.hl7.org/CodeSystem/measure-scoring

code: proportion

display: Proportion

Improvement Notation:

system: http://terminology.hl7.org/CodeSystem/measure-improvement-notation

code: increase

display: Increased score indicates improvement

Type:

system: http://terminology.hl7.org/CodeSystem/measure-type

code: process

Date: 2021-04-03
Publisher: Clinical Quality Information WG
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.
Parameters:
nameuseminmaxtype
Measurement Period in 0 1 Period
Numerator out 0 * Encounter
Strep Test Encounters out 0 * Encounter
Pharyngitis Encounters With Antibiotics out 0 * Encounter
Measurement Period Encounters out 0 * Encounter
Is Between 2 and 17 Years of Age at Start of Measurement Period out 0 1 boolean
Pharyngitis out 0 * Condition
Antibiotics out 0 * MedicationRequest
Initial Population out 0 * Encounter
Data Requirements:
typepathvalueSet or systemcode
Encounter type http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
Condition code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
Condition code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
Observation code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
Direct Reference Codes:
displaycodesystem
active
confirmed
Use Context:
codevalue
program
Jurisdiction: US
Topic: 57024-2
Purpose: 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).
Copyright: 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.
Disclaimer: 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].
Approval Date: 2016-01-01
Last Review Date: 2016-09-01
Effective Period: 2018-01-01..2018-12-31
Related Artifacts:

Dependencies

  • http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
  • http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000
  • http://hl7.org/fhir/us/cqfmeasures/Library/Common|2.0.0
  • http://terminology.hl7.org/CodeSystem/condition-clinical
  • http://terminology.hl7.org/CodeSystem/condition-verification
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
Logic Definitions:
Library NameNamesequence
EXM146 Numerator 
define "Numerator":
   "Strep Test Encounters"


Library NameNamesequence
EXM146 Strep Test Encounters 
// EndRegion: Denominator Exclusions

// Region: Denominator Exceptions

// None

// EndRegion: Denominator Exceptions

// Region: Numeratordefine "Strep Test Encounters":
   "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]


Library NameNamesequence
EXM146 Pharyngitis Encounters With Antibiotics 
define "Pharyngitis Encounters With Antibiotics":
   "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)


Library NameNamesequence
EXM146 Measurement Period Encounters 
define "Measurement Period Encounters":
   [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"


Library NameNamesequence
EXM146 Is Between 2 and 17 Years of Age at Start of Measurement Period 
// Region: Initial Populationdefine "Is Between 2 and 17 Years of Age at Start of Measurement Period":
   AgeInYearsAt(start of "Measurement Period") >= 2
      and AgeInYearsAt(start of "Measurement Period") <= 17


Library NameNamesequence
EXM146 Pharyngitis 
define "Pharyngitis":
   ([Condition: code in "Acute Pharyngitis"]
     union [Condition: code in "Acute Tonsillitis"]) Pharyngitis
     where Pharyngitis.clinicalStatus ~ Global.active
       and Pharyngitis.verificationStatus ~ Global.confirmed


Library NameNamesequence
EXM146 Antibiotics 
define "Antibiotics":
   [MedicationRequest: medication in "Antibiotic Medications"] Prescription
     where Prescription.status = 'active'
       and Prescription.intent = 'order'


Library NameNamesequence
EXM146 Initial Population 
define "Initial Population":
   "Pharyngitis Encounters With Antibiotics"