Appropriate Testing for Children with Pharyngitis (NQF 0002)

eMeasure Name Appropriate Testing for Children with Pharyngitis eMeasure Id 2E679CD2-3FEC-4A75-A75A-61403E5EFEE8
Version number 1 eMeasure Set Id B5FEE67F-F5C4-4C73-9D58-1941F9729539
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of children 2–18 years of age who were diagnosed with Pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This measure assesses the proportion of age-appropriate children diagnosed with pharyngitis who were prescribed an antibiotic at an outpatient visit and who received a group A streptococcus (group A strep) test. Pharyngitis occurs in all age groups, but those aged 5-18 years have the highest incidence of streptococcal infections. A physician's clinical diagnosis can be validated with an objective diagnostic (group A strep) test. This test, which is widely available to practitioners, can result in a reduction of two-thirds of antibiotic consumption of pharyngitis while maintaining significant benefits for patients. In a recent nationwide physician survey, however, 42% of physicians reported that they would start antibiotic treatment for children with pharyngitis before knowing the results of a group A strep test, and would continue treatment regardless. This measure is important because it requires initial antigen screening to ensure accurate diagnosis and promotes judicious use of antibiotics and reduction of antibiotic overuse.
Clinical Recommendation Statement
Clinical practice guidelines recommend group A streptococcus pharyngitis be treated with antibiotics. 

Specifically, the guidelines set out 3 principles:
1. Diagnosis of group A strep. pharyngitis is based on appropriate lab tests and clinical/epidemiological findings
2. Antibiotics are only given with a diagnosis of group A strep. pharyngitis or other bacterial infection
3. Penicillin is the drug of choice for group A strep. pharyngitis

The group A strep. test (rapid assay or throat culture) is the definitive test of group A strep. pharyngitis. Pharyngitis is the only respiratory tract infection with an objective diagnostic test that can be validated with administrative data, and not medical records. A process measure that requires the performance of a group A strep. test for children given antibiotics for pharyngitis is supported by the guidelines.
Improvement notation
Higher scores indicate better quality
Measurement duration
12 month(s)
Reference
Schwartz B, Marcy SM, Phillips WR, Gerber MA, Dowell SF. Pharyngitis - principles of judicious use of antimicrobial agents. Pediatrics 1998; 101(1):171-174.
Definition
Initial Patient Population(s): All children 2 years to 18 years of age at the beginning of the measurement period.
Definition
Denominator(s): 
Patients in the initial population who had an outpatient or emergency department (ED) encounter with only a diagnosis of pharyngitis and were dispensed an antibiotic for that episode of care.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): 
The number of patients who had a group A streptococcus test in the seven-day period from three days prior to the encounter during which pharyngitis was diagnosed through three days after that encounter.
Definition
Denominator Exception(s): N/A
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012