EXM146-FHIR
type: Measure
node role: treeRoot
id:
  v: EXM146-FHIR
meta:
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-proportionmeasure
    l: cqm-proportionmeasure
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
    l: cqm-computablemeasure
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure
    l: cqm-cqlmeasure
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
    l: cqm-computablemeasure
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Metadata Title EXM146 - Appropriate Testing for Children with Pharyngitis Version 4.0.0 Identifier 146 Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.7 Effective Period 2018-01-01 through 2018-12-31 Approval Date 2016-01-01 Last Review Date 2016-09-01 Experimental true Use Context Clinical Venue = EC Jurisdiction Global (Whole world) Topic Health Quality Measure Document Steward (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. Purpose This measure has been developed to support improvement in clinical care. 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) (SNOM…
contained: Library
  id:
    v: effective-data-requirements
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: active
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-ver-status
        l: condition-ver-status
      code:
        v: confirmed
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM146
    extension:
      url:
        v: name
        l: name
      value: String
        v: Is Between 2 and 17 Years of Age at Start of Measurement Period
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: 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
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 0
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM146
    extension:
      url:
        v: name
        l: name
      value: String
        v: Measurement Period Encounters
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: 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"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 1
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM146
    extension:
      url:
        v: name
        l: name
      value: String
        v: Pharyngitis
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Pharyngitis": ([Condition: code in "Acute Pharyngitis"] union [Condition: code in "Acute Tonsillitis"]) Pharyngitis where Pharyngitis.clinicalStatus ~ Global.active and Pharyngitis.verificationStatus ~ Global.confirmed
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 2
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM146
    extension:
      url:
        v: name
        l: name
      value: String
        v: Antibiotics
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Antibiotics": [MedicationRequest: medication in "Antibiotic Medications"] Prescription where Prescription.status = 'active' and Prescription.intent = 'order'
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 3
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM146
    extension:
      url:
        v: name
        l: name
      value: String
        v: Pharyngitis Encounters With Antibiotics
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: 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)
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 4
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM146
    extension:
      url:
        v: name
        l: name
      value: String
        v: Strep Test Encounters
    extension:
      url:
        v: statement
        l: statement
      value: String

String
v: 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]

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 5

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM146
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator": "Strep Test Encounters"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM146
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Initial Population": "Pharyngitis Encounters With Antibiotics"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM146
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": "Initial Population"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM146
extension:
  url:
    v: name
    l: name
  value: String
    v: Pharyngitis With Prior Antibiotics
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Pharyngitis With Prior Antibiotics": "Pharyngitis" Pharyngitis with "Antibiotics" Antibiotics such that Antibiotics.authoredOn 30 days or less before Pharyngitis.onset
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM146
extension:
  url:
    v: name
    l: name
  value: String
    v: Excluded Encounters
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Excluded Encounters": "Pharyngitis Encounters With Antibiotics" Encounters with "Pharyngitis With Prior Antibiotics" Pharyngitis such that Common."Includes Or Starts During"(Pharyngitis, Encounters)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM146
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exclusions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exclusions": "Excluded Encounters"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToInterval
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value EncounterStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToConcept
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToCode
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: Common
extension:
  url:
    v: name
    l: name
  value: String
    v: Includes Or Starts During
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "Includes Or Starts During"(Condition Condition, Encounter Encounter): Interval[Condition.onset, Condition.abatement] includes Encounter.period or Condition.onset during Encounter.period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToDateTime
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToDateTime(value dateTime): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value MedicationRequestStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 18
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value MedicationRequestIntent): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 19
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

v: EffectiveDataRequirements

v: active

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/library-type
    l: library-type
  code:
    v: module-definition

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
  l: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library Global
resource:
  v: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000
  l: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions

type:
  v: depends-on
display:
  v: Library Common
resource:
  v: http://hl7.org/fhir/uv/cqm/Library/Common|2.0.0
  l: http://hl7.org/fhir/uv/cqm/Library/Common

type:
  v: depends-on
display:
  v: Code system ConditionClinicalStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-clinical
  l: condition-clinical

type:
  v: depends-on
display:
  v: Code system ConditionVerificationStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-ver-status
  l: condition-ver-status

type:
  v: depends-on
display:
  v: Value set Ambulatory/ED Visit
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061

type:
  v: depends-on
display:
  v: Value set Acute Pharyngitis
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011

type:
  v: depends-on
display:
  v: Value set Acute Tonsillitis
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012

type:
  v: depends-on
display:
  v: Value set Antibiotic Medications
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001

type:
  v: depends-on
display:
  v: Value set Group A Streptococcus Test
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012

name:
  v: Measurement Period
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: Period

name:
  v: Numerator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

name:
  v: Denominator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

name:
  v: Initial Population
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

name:
  v: Denominator Exclusions
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/StructureDefinition/Patient
  l: Patient

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/StructureDefinition/Encounter
  l: Encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: code
must support:
  v: clinicalStatus
must support:
  v: verificationStatus
must support:
  v: onset
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: code
must support:
  v: clinicalStatus
must support:
  v: verificationStatus
must support:
  v: onset
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: medication
must support:
  v: status
must support:
  v: intent
must support:
  v: authoredOn
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/StructureDefinition/Observation
  l: Observation
must support:
  v: code
must support:
  v: value
must support:
  v: effective
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012

url:
  v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis
  l: cqm-populationBasis
value: Code
  v: Encounter

url:
  v: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
  l: crmi-softwaresystem
value: Reference
  l: software-system-example
  reference:
    v: Device/software-system-example

id:
  v: effective-data-requirements
url:
  v: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
  l: crmi-effectiveDataRequirements
value: Canonical
  v: #effective-data-requirements
  l: effective-data-requirements

use:
  v: official
system:
  v: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm
  l: exm
value:
  v: 146

system:
  v: urn:ietf:rfc:3986
  l: 3986
value:
  v: urn:oid:2.16.840.1.113883.4.642.40.61.29.7

v: 4.0.0

v: EXM146

v: EXM146 - Appropriate Testing for Children with Pharyngitis

v: active

v: true

v: 2025-08-13

v: HL7 International / Clinical Quality Information

telecom:
  system:
    v: url
  value:
    v: http://www.hl7.org/Special/committees/cqi

v: 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.

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: venue
  display:
    v: Clinical Venue
value: CodeableConcept
  coding:
    system:
      v: http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes
      l: intended-venue-codes
    code:
      v: ec
    display:
      v: EC

coding:
  system:
    v: http://unstats.un.org/unsd/methods/m49/m49.htm
    l: m49.htm
  code:
    v: 001

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

v: 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.

v: 2016-01-01

v: 2016-09-01

start:
  v: 2018-01-01
end:
  v: 2018-12-31

coding: https://loinc.org/rdf/57024-2
  system:
    v: http://loinc.org
    l: loinc.org
  code:
    v: 57024-2
  display:
    v: Health Quality Measure Document

v: 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].

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-scoring
    l: measure-scoring
  code:
    v: proportion
  display:
    v: Proportion

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-type
    l: measure-type
  code:
    v: process

v: 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).

v: 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)

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-improvement-notation
    l: measure-improvement-notation
  code:
    v: increase
  display:
    v: Increased score indicates improvement

v: 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.

id:
  v: group-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId
    l: extension-Measure.group.linkId
  value: String
    v: primary
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm146-initial-population
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: initial-population
      display:
        v: Initial Population
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm146-numerator
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator
      display:
        v: Numerator
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm146-denominator
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator
      display:
        v: Denominator
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm146-denominator-exclusion
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exclusion
      display:
        v: Denominator Exclusion
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exclusions