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Appropriate Treatment for Children With Upper Respiratory Infection (URI)

CBE ID
0069
Project
Primary Care and Chronic Illness
Endorsed
New or Maintenance
Maintenance
Endorsement and Maintenance (E&M) Cycle
Fall 2020
Is Under Review
No
Measure Description

The Appropriate Treatment for Upper Respiratory Infection (URI) measure assesses whether members 3 months of age and older with a diagnosis of upper respiratory infection were not dispensed an antibiotic prescription. The measure includes patients enrolled in commercial, Medicaid, and Medicare health plans.

  • Measure Type
    Process
    Electronic Clinical Quality Measure (eCQM)
    No
    Level Of Analysis
    Health Plan
    Care Setting
    Emergency Department and Services
    Outpatient Services
    Numerator

    The numerator of the measure includes the number of dispensed prescriptions for an antibiotic medication on or 3 days after the Episode Date.

    Denominator

    Episodes for members 3 months of age and older as of July 1 of the year prior to the measurement year who had an outpatient, telephone, e-visit or virtual check-in, an observation visit or ED encounter with a diagnosis of upper respiratory infection (URI) during the intake period (July 1st of the year prior to the measurement year to June 30th of the measurement year).

    Exclusions

    Exclude visits that result in an inpatient stay.

    Exclude Episode Dates when the member had a claim/encounter with any diagnosis for a comorbid condition during the 12 months prior to or on the Episode Date.

    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.

    Exclude Episode Dates where the patient had a claim/encounter with a competing diagnosis on or three days after the Episode Date.

    Testing Data Sources
    Claims Data
  • Most Recent Endorsement Activity
    Endorsed Primary Care and Chronic Illness Fall Cycle 2020
    Initial Endorsement
    Next Planned Maintenance Review
    Primary Care and Chronic Illness Fall 2024
    Endorsement Status
    Endorsed
    Last Updated