Treatment for Children with Upper Respiratory Infection (URI): Avoidance of Inappropriate Use (NQF 0069)

EMeasure Name Treatment for Children with Upper Respiratory Infection (URI): Avoidance of Inappropriate Use EMeasure Id 7172D5B7-29FE-4B8F-9217-BABA7B86FA1D
Version number 1 Set Id 15971D14-BB2D-48A8-8B4C-AC9C67E1BC29
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 Percentage of children who were given a diagnosis of URI and were not dispensed an antibiotic prescription on or three days after the episode date.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
In 1998, there were approximately 84 million office visits for acute respiratory infections.  During this same period 45 million antibiotic prescriptions were issued. (Gonzales, 2001)  Thus slightly more than half of these visits resulted in an antibiotic prescription being issued.  During this same time period, 25 million patients (adults and children) sought care for non-specific URI (the common cold) and 30% received antibiotics. (Gonzales, 2001)  

In 1997-98, for children less than 15 years old, 74% of ambulatory antibiotic prescriptions in the U.S. were for the treatment of acute respiratory infections: otitis media, sinusitis, pharyngitis, bronchitis and upper respiratory infections (CDC unpublished data). Inappropriate use of antibiotics remains a widespread problem in this population. Despite national campaigns to reduce inappropriate antibiotic use and ensuing reduction in antibiotic prescriptions, inappropriate antibiotic use remains high and is a cause for concern in the population. 

URI, pharyngitis and bronchitis are conditions associated with the greatest amount of excess use of antibiotics. A total $1322 million was spent on antibiotic prescriptions for otitis media, pharyngitis, URI, sinusitis, and bronchitis in 1998. Of this $227 million was spent on antibiotics for patients with URI. (Note costs are estimated based on average pharmacy retail price, as provided by Source Prescription Database of NDC Health Information Service). (Gonzales, 2001)  Inappropriate antibiotic prescriptions for URI, pharyngitis, and bronchitis are estimated to amount to 55% (22.6 million) of all antibiotics prescribed for acute respiratory infections, costing $726 million in 1998. 

The economic costs of antibiotic resistance resulting from misuse of antibiotics have also been estimated. The Office of Technology Assessment (OTA) calculated the direct costs of antibiotic resistance to hospitals alone to be $1.3 billion in 1992 dollars, or $1.9 billion in 2001 dollars (adjusted with the Medical Care Component of the Consumer Price Index). The costs of nosocomial infections (5 classes) were estimated at $4.5 billion in 1990 dollars ($7.7 billion in 2001 dollars) by the CDC. However, these figures underestimate the total cost of antibiotic resistance as they do not include the costs of antibiotic resistance in the community, the high costs of developing new antibiotics to replace old antibiotics that are ineffective against resistant bacteria, or the costs of death to society. (OTA, 1995)  The overall economic impact of resistance on society has been estimated at about $350 million to $35 billion annually, based on 150 million annual antibiotic prescriptions. (Phelps, 1989) 

The measure would encourage appropriate use of antibiotics by physicians, which would lead to cost-effective prescribing behaviors, eliminating and reducing unnecessary antibiotic use and decreasing antibiotic resistance in the community. The reduction of antibiotic use would also lead to the decreased health care costs arising from the serious morbidity and mortality associated with increased antibiotic resistance in the community. (Feikin, 2000) The greater difficulty to treat drug-resistant pathogens results in more repeated health care visits, greater risk of disease complications, and increased health care costs. (Feikin, 2000; Dagan, 2000; Watanabe, 2000)
Clinical Recommendation Statement
Guidelines for the Use of Antibiotics in Acute Upper Respiratory Tract Infections. American Family Physician 2006. 

- A diagnosis of acute bacterial rhinosinusitis should be considered in patients with symptoms of a viral upper respiratory infection that have not improved after 10 days or that worsen after five to seven days. (C) 

- Treatment of sinus infection with antibiotics in the first week of symptoms is not recommended. (C)

- Telling patients not to fill an antibiotic prescription unless symptoms worsen or fail to improve after several days can reduce the inappropriate use of antibiotics. (B)
Improvement notation
Higher scores indicates better quality
Measurement duration
12 month(s)
Reference
Am Fam Physician. 2006 Sep 15;74(6):956-966.
Reference
Dagan R. Clinical significance of resistant organisms in otitis media. Pediatric Infectious Disease Journal 2000; 19(4):378-382.
Reference
Feikin DR, Schuchat A, Kolczak M, Barrett NL, Harrison LH, Lefkowitz L et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. American Journal of Public Health 2000; 90(2):223-229.
Reference
Gonzales R., Malone D.C., Maselli JH., Sande M.A. Excessive antibiotic use for acute respiratory infections in the United States. Clinical Infectious Diseases 2001; 33:757-762.
Reference
OTA impact of antibiotic-resistant bacteria: a report to the US Congress, 1995. OTA-H-629. 1995. Washington DC, Office of Technology Assessment.
Reference
Phelps C.E. Bug/drug resistance: sometimes more is less. Medical Care 1989; 27:194-203.
Reference
Watanabe H, Sato S, Kawakami K, Watanabe K, Oishi K, Rikitomi N et al. A comparative clinical study of pneumonia by penicillin-resistant and sensitive Streptococcus pneumoniae in a community hospital. Respirology 2000; 5(1):59-64.
Definition
Guidance

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012