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CMS 154 - Appropriate Treatment for Upper Respiratory Infection (URI)

Updated: 06/14/2023|Views: 1135

CMS 154 / Quality ID #065

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order.

Denominator: Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.
  • Patient’s age is calculated based on the patient’s Date of Birth, which was entered when you created the patient’s account.
  • Create a note detailing the patient’s office visit.
  • The diagnosis of "Upper Respiratory Infection (URI)" is entered in the patient’s Problems with a Start Date.
Denominator Exclusions: Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.
  • Competing conditions are documented under Problems with a Start Date. These patients will be excluded from the denominator.

Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, but is still active the same day of the encounter.

  • Patient will need to have "Pharyngitis" under Problems with a Start Date within the previous 30 days.
  • Antibiotics are prescribed in Medications with a Start Date that is within the 30 days prior to the date of the diagnosis.

Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date.

  • Competing diagnosis is documented under Problems with a Start Date. These patients will be excluded from the denominator.

Exclude patients who are in hospice care for any part of the measurement period.

  • Hospice is documented under Hospice in History. These patients will be excluded from the denominator.
Numerator: URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection.
  • Patients for whom there is no antibiotic listed in Medications with a Start Date on or within 3 days of the Start Date of the Problem.
Office Visit Documentation:

Once all steps have been completed, the measure will be added to the Quality Measures Report.

Measure type: Process
High Priority Measure: Yes
Telehealth Eligible: Yes
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