CMS154v13: Appropriate Treatment for Upper Respiratory Infection (URI)

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

Numerator

URI Episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, virtual encounter, or emergency department (ED) visit

Denominator

Outpatient visits, telephone visits, virtual encounter, or emergency department (ED) visits with a diagnosis of upper respiratory infection (URI) from January 1st to December 28th the measurement period for patients 3 months of age and older

Exclusions:

  • Exclude URI episodes when the patient had a competing co-morbid condition during the 12 months prior to or on the episode date
  • Exclude URI episodes when the patient had an is taking anibiotics in the 30 days prior to the episode date, but is still avtive the same day of the encounter
  • Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date
  • Exclude URI episodes when the patient had hospice care for any part of the measurement period.
    • Identified in the patient's Alerts and Directives, located in the demographic screen or the Summary Sheet, in the name, text or comments saved with that alert/directive. The Alert/Directive should include either of the following phrases:
      • palliative
      • hospice