Quality Measure Implementation Guide (STU5)
5.0.0-ballot - ballot United States of America flag

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v5.0.0-ballot: STU5 (v5.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 4.0.0. For a full list of available versions, see the Directory of published versions

Example Measure: EXM146 - Appropriate Testing for Children with Pharyngitis

Active as of 2022-02-22
Id: EXM146-FHIR
Download cql: EXM146-FHIR.cql
Url: EXM146 - Appropriate Testing for Children with Pharyngitis
Version: 5.0.0-ballot
Identifier:

value: 146

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

Proportion

Improvement Notation:

Increased score indicates improvement

Type:

process

Date: 2022-02-22
Publisher: HL7 International / Clinical Quality Information
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.

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
Libraries:
EXM146 - Example Proportion Measure Library
Related Artifact Dependencies:
  • http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
  • MAT Global Common Functions FHIR Library
  • http://hl7.org/fhir/us/cqfmeasures/Library/Common|2.0.0
  • Condition Clinical Status Codes
  • ConditionVerificationStatus
  • Ambulatory/ED Visit
  • Acute Pharyngitis
  • Acute Tonsillitis
  • Antibiotic Medications for Pharyngitis
  • Group A Streptococcus Test
  • Parameters:
    nameuseminmaxtype
    Measurement Period in 0 1 Period
    Numerator out 0 * Encounter
    Initial Population out 0 * Encounter
    DataRequirements:
    TypeMust SupportValueset NameValueset
    Condition code Acute Pharyngitis Acute Pharyngitis
    Condition code Acute Tonsillitis Acute Tonsillitis
    Observation effective code value Group A Streptococcus Test Group A Streptococcus Test
    Patient
    Encounter period type status Ambulatory/ED Visit Ambulatory/ED Visit
    MedicationRequest authoredOn medication intent status Antibiotic Medications Antibiotic Medications for Pharyngitis
    Direct Reference Codes:
    displaycodesystem
    active Condition Clinical Status Codes
    confirmed ConditionVerificationStatus
    Logic Definitions:
    GroupScoringPopulation CriteriaExpression
    Measure scoring:

    Proportion

    Initial Population
    define "Initial Population":
       "Pharyngitis Encounters With Antibiotics"
    Numerator
    define "Numerator":
       "Strep Test Encounters"
    Denominator
    Denominator Exclusion
    Library NameName
    EXM146-FHIR Is Between 2 and 17 Years of Age at Start of Measurement Period
    // Region: Initial Population
    define "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 NameName
    EXM146-FHIR 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 NameName
    EXM146-FHIR 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 NameName
    EXM146-FHIR Antibiotics
    define "Antibiotics":
       [MedicationRequest: medication in "Antibiotic Medications"] Prescription
         where Prescription.status = 'active'
           and Prescription.intent = 'order'
    Library NameName
    EXM146-FHIR 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 NameName
    EXM146-FHIR Strep Test Encounters
    // EndRegion: Denominator Exclusions
    
    // Region: Denominator Exceptions
    
    // None
    
    // EndRegion: Denominator Exceptions
    
    // Region: Numerator
    define "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 NameName
    EXM146-FHIR Numerator
    define "Numerator":
       "Strep Test Encounters"
    Library NameName
    EXM146-FHIR Initial Population
    define "Initial Population":
       "Pharyngitis Encounters With Antibiotics"

    Contained resources