Appropriate Treatment for Upper Respiratory Infection (URI)
Based on current NCQA HEDIS recommendations, your TO-DO LIST for members 3 months of age or older should include:
- Dispensed prescription for an antibiotic medication on or 3 days after the Episode Date.
Why should you complete your TO-DO LIST?
It is an evidence-based, best practice and these actions are used to measure your quality performance.
HEDIS Appropriate Treatment for Upper Respiratory Infection (URI) Definition:
(NCQA HEDIS guidelines, Measurement Year (MY) 2022)
- The percentage of episodes for members 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.
- Line of Business: Commercial, Medicaid, Medicare
- Dispensed prescription for an antibiotic medication from the ABB Antibiotic List on or 3 days after the Episode Date.
The measure is reported as an inverted rate [1–(numerator/eligible population)]. A higher rate indicates appropriate URI treatment (i.e., the proportion of episodes that did not result in an antibiotic dispensing event).
AAB Antibiotic Medications
|Aminoglycosides||Amikacin, Gentamicin, Streptomycin, Tobramycin|
|Beta-lactamase inhibitors||Amoxicillin-clavulanate, Ampicillin-sulbactam, Piperacillin-tazobactam|
|First-generation cephalosporins||Cefadroxil, Cefazolin, Cephalexin|
|Lincomycin derivatives||Clindamycin, Lincomycin|
|Macrolides||Azithromycin, Clarithromycin, Erythromycin|
|Miscellaneous antibiotics||Aztreonam, Chloramphenicol, Dalfopristin-quinupristin, Daptomycin, Linezolid, Metronidazole, Vancomycin|
|Natural penicillins||Penicillin G benzathine-procaine, Penicillin G potassium, Penicillin G procaine, Penicillin G sodium, Penicillin V potassium, Penicillin G benzathine|
|Penicillinase resistant penicillins||Dicloxacillin, Nafcillin, Oxacillin|
|Quinolones||Ciprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin, Ofloxacin|
|Second-generation cephalosporin||Cefaclor, Cefotetan Cefoxitin, Cefprozil, Cefuroxime|
|Tetracyclines||Doxycycline, Minocycline, Tetracycline|
|Third-generation cephalosporins||Cefdinir, Cefditoren, Cefixime, Cefotaxime, Cefpodoxime, Ceftazidime, Ceftibuten, Ceftriaxone|
|Urinary anti-infectives||Fosfomycin, Nitrofurantoin, Nitrofurantoin macrocrystals-monohydrate, Trimethoprim|
To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please contact Horizon Healthy Journey: 1-844-754-2451.
Reference: NCQA HEDIS Measurement Year (MY) 2022 Technical Specs CPT® is a registered trademark of the American Medical Association.