Quality Measure Implementation Guide
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Quality Measure Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 6.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-measures/ and changes regularly. See the Directory of published versions

Measure: Cervical Cancer EXM146 - Appropriate Testing for Children with Pharyngitis (Experimental)

Official URL: http://hl7.org/fhir/uv/cqfmeasures/Measure/EXM146-FHIR Version: 4.0.0
Active as of 2022-02-22 Computable Name: EXM146
Other Identifiers: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm#146 (use: official, )

Usage:Venue: EC

Copyright/Legal: 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.

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.

This measure has been developed to support improvement in clinical care.

Knowledge Artifact Metadata
Name (machine-readable) EXM146
Title (human-readable) EXM146 - Appropriate Testing for Children with Pharyngitis
Status Active
Experimental true
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.

Purpose

This measure has been developed to support improvement in clinical care.

Approval Date 2016-01-01
Effective Period 2018-01-01..2018-12-31
Use Context Venue = EC
Topic Health Quality Measure Document
Measure Steward HL7 International / Clinical Quality Information
Steward Contact Details http://www.hl7.org/Special/committees/cqi
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.

Measure Metadata
Version Number 4.0.0
Measure Scoring Proportion
Measure Type Process
Rationale

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).

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)

Improvement Notation Increased score indicates improvement
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.

Measure Population Criteria
Initial Population Description: No description provided Logic Definition: Initial Population
Numerator Description: No description provided Logic Definition: Numerator
Denominator Description: No description provided Logic Definition: Denominator
Denominator Exclusion Description: No description provided Logic Definition: Denominator Exclusion
Measure Logic
Primary Library EXM146 - Example Proportion Measure Library
Dependency Description: Library FHIRHelpers
Resource: http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
Canonical URL: http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
Dependency Description: Library Global
Resource: MAT Global Common Functions FHIR Libraryversion: null5.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000
Dependency Description: Library Common
Resource: Common Libraryversion: null2.0.0)
Canonical URL: http://hl7.org/fhir/uv/cqfmeasures/Library/Common|2.0.0
Dependency Description: Code system ConditionClinicalStatusCodes
Resource: Condition Clinical Status Codes
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical
Dependency Description: Code system ConditionVerificationStatusCodes
Resource: ConditionVerificationStatus
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status
Dependency Description: Value set Ambulatory/ED Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
Dependency Description: Value set Acute Pharyngitis
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
Dependency Description: Value set Acute Tonsillitis
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
Dependency Description: Value set Antibiotic Medications
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
Dependency Description: Value set Group A Streptococcus Test
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
Direct Reference Code Code: active
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Direct Reference Code Code: confirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Parameter Name: Measurement Period
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: Period
Parameter Name: Numerator
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: Initial Population
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Measure Logic Data Requirements
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
Data Requirement Type: Observation
Profile(s): Observation
Must Support Elements: effective, code, value
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
Data Requirement Type: Patient
Profile(s): Patient
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: period, type, status
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
Data Requirement Type: MedicationRequest
Profile(s): MedicationRequest
Must Support Elements: authoredOn, medication, intent, status
Code Filter(s):
Path: medication
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
Measure Logic Definitions
Logic Definition Library Name: EXM146-FHIR
// 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
Logic Definition Library Name: EXM146-FHIR
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"
Logic Definition Library Name: EXM146-FHIR
define "Pharyngitis":
   ([Condition: code in "Acute Pharyngitis"]
     union [Condition: code in "Acute Tonsillitis"]) Pharyngitis
     where Pharyngitis.clinicalStatus ~ Global.active
       and Pharyngitis.verificationStatus ~ Global.confirmed
Logic Definition Library Name: EXM146-FHIR
define "Antibiotics":
   [MedicationRequest: medication in "Antibiotic Medications"] Prescription
     where Prescription.status = 'active'
       and Prescription.intent = 'order'
Logic Definition Library Name: EXM146-FHIR
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)
Logic Definition Library Name: EXM146-FHIR
// 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]
Logic Definition Library Name: EXM146-FHIR
define "Numerator":
   "Strep Test Encounters"
Logic Definition Library Name: EXM146-FHIR
define "Initial Population":
   "Pharyngitis Encounters With Antibiotics"
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