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
Requirement:
- 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
| Description: | Prescription | ||
| Aminoglycosides | Amikacin, Gentamicin, Streptomycin, Tobramycin | ||
| Aminopenicillins | Amoxicillin, Ampicillin | ||
| Beta-lactamase inhibitors | Amoxicillin-clavulanate, Ampicillin-sulbactam, Piperacillin-tazobactam | ||
| First-generation cephalosporins | Cefadroxil, Cefazolin, Cephalexin | ||
| Fourth-generation cephalosporins | Cefepime | ||
| Ketolides | Telithromycin | ||
| 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 | ||
| Rifamycin derivatives | Rifampin | ||
| Second-generation cephalosporin | Cefaclor, Cefotetan Cefoxitin, Cefprozil, Cefuroxime | ||
| Sulfonamides | Sulfadiazine, Sulfamethoxazole-trimethoprim | ||
| 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.