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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.