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Measure Summary
This measure is endorsed by the National Quality Forum
Title
Avoidance of antibiotic treatment in adults with acute bronchitis: percentage of adults 18 to 64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription.
Source(s)
National Committee for Quality Assurance (NCQA). HEDIS 2014: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2013. various p.

National Committee for Quality Assurance (NCQA). HEDIS 2014: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2013. various p.

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure

Brief Abstract

Description

This measure is used to assess the percentage of adults 18 to 64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription on or three days after the Index Episode Start Date (IESD).

This measure assesses whether antibiotics were inappropriately prescribed for healthy adults 18 to 64 years of age with bronchitis and builds on an existing HEDIS measure that targets inappropriate antibiotic prescribing for children with upper respiratory infection (URI). See the related National Quality Measures Clearinghouse (NQMC) summary of the National Committee for Quality Assurance (NCQA) measure Appropriate treatment for children with upper respiratory infection (URI): percentage of children 3 months to 18 years of age who were given a diagnosis of URI and were not dispensed an antibiotic prescription.

This measure is reported as an inverted rate (1 - [numerator/eligible population]). A higher rate indicates appropriate treatment of adults with acute bronchitis (i.e., proportion for whom antibiotics were not prescribed).

Note from the National Quality Measures Clearinghouse (NQMC): Measure specifications reference value sets that must be used for HEDIS reporting. In this NQMC measure summary, value set references are capitalized and underlined. A value set is the complete set of codes used to identify the service or condition included in the measure. Refer to the original measure documentation for the Value Set Directory.

Rationale

Antibiotics are most often inappropriately prescribed for adults with acute bronchitis. Antibiotics are not indicated in clinical guidelines for treating adults with acute bronchitis who do not have a comorbidity or other infection for which antibiotics may be appropriate. Inappropriate antibiotic treatment of adults with acute bronchitis is of clinical concern, especially since misuse and overuse of antibiotics lead to antibiotic drug resistance. Acute bronchitis consistently ranks among the 10 conditions that account for the most ambulatory office visits to United States (U.S.) physicians; furthermore, while the vast majority of acute bronchitis cases (more than 90 percent) have a nonbacterial cause, antibiotics are inappropriately prescribed 65 to 80 percent of the time.

Evidence for Rationale
Gonzales R, Bartlett JG, Besser RE, Cooper RJ, Hickner JM, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods. Ann Intern Med. 2001 Mar 20;134(6):479-86. PubMed External Web Site Policy

Gonzales R, Bartlett JG, Besser RE, Hickner JM, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background. Ann Intern Med. 2001 Mar 20;134(6):490-4. [34 references]

Gonzales R, Malone DC, Maselli JH, Sande MA. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001 Sep 15;33(6):757-62. PubMed External Web Site Policy

McCaig LF, Besser RE, Hughes JM. Antimicrobial drug prescription in ambulatory care settings, United States, 1992-2000. Emerg Infect Dis. 2003 Apr;9(4):432-7. PubMed External Web Site Policy

National Committee for Quality Assurance (NCQA). HEDIS 2014: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2013. various p.

Steinman MA, Sauaia A, Maselli JH, Houck PM, Gonzales R. Office evaluation and treatment of elderly patients with acute bronchitis. J Am Geriatr Soc. 2004 Jun;52(6):875-9. PubMed External Web Site Policy
Primary Health Components

Acute bronchitis; antibiotic treatment

Denominator Description

Health plan members 18 years of age as of January 1 of the year prior to the measurement year to 64 years of age as of December 31 of the measurement year, with a Negative Medication History, a Negative Comorbid Condition History and a Negative Competing Diagnosis, who had an outpatient visit, an observation visit or an emergency department (ED) visit with any diagnosis of acute bronchitis during the Intake Period (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Dispensed a prescription for antibiotic medication on or three days after the Index Episode Start Date (IESD) (see the related "Numerator Inclusions/Exclusions" field)

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
  • Acute bronchitis, or chest cold, is a cough that lasts approximately two weeks. The majority of acute bronchitis infections are caused by viruses, but antibiotics continue to be prescribed despite strong recommendations against using antibiotics for routine treatment.
  • Acute bronchitis is among the top 10 conditions that result in a visit to the doctor. Each year, approximately 5 percent of United States (U.S.) adults self-report cases of acute bronchitis; 90 percent of those seek medical attention, accounting for more than 10 million office visits.
  • Although almost all acute bronchitis infections are caused by viruses, more than 60 percent of patients are treated with antibiotics. Use of antibiotics in treating acute bronchitis has not been found to be effective.
  • Acute bronchitis is the cause of a large number of emergency department (ED) visits. In a two-year span, more than 2 million cases of bronchitis were diagnosed by ED physicians. Bronchitis was more likely to be treated with an antibiotic than any other respiratory condition.
  • Antibiotic use contributes to the growing problem of antibiotic-resistant bacteria. The U.S. spends approximately $55 billion in related health service costs and lost productivity.
  • No studies have found antibiotics to be effective in cases of viral infection, but providers often feel pressured to prescribe them to patients with acute bronchitis to meet their expectations and increase satisfaction.
  • Reducing the amount of antibiotics prescribed for acute bronchitis is necessary to address the growing public health issue of antibiotic-resistant bacteria. Better communication between providers and patients can help patients understand the appropriate uses and risks of antibiotics.
Evidence for Additional Information Supporting Need for the Measure
Albert RH. Diagnosis and treatment of acute bronchitis. Am Fam Physician. 2010 Dec 1;82(11):1345-50. PubMed External Web Site Policy

Centers for Disease Control and Prevention. Acute cough illness (acute bronchitis). [internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2009 Jun 30 [accessed 2013 Jun 01].

Centers for Disease Control and Prevention. Get smart: know when antibiotics work-bronchitis (chest cold). [internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2009 Jun 30 [accessed 2013 Jun 01].

Gonzales R, Malone DC, Maselli JH, Sande MA. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001 Sep 15;33(6):757-62. PubMed External Web Site Policy

National Committee for Quality Assurance (NCQA). Improving quality and patient experience. The state of health care quality 2013. Washington (DC): National Committee for Quality Assurance (NCQA); 2013 Oct. 203 p.

Smith R, Coast J. The true cost of antimicrobial resistance. BMJ. 2013;346:f1493. PubMed External Web Site Policy

Wark PA. Clinical evidence concise: bronchitis (acute). Am Fam Physician. 2004;70(3):557-8.

Xu KT, Roberts D, Sulapas I, Martinez O, Berk J, Baldwin J. Over-prescribing of antibiotics and imaging in the management of uncomplicated URIs in emergency departments. BMC Emerg Med. 2013;13:7. PubMed External Web Site Policy
Extent of Measure Testing

Unspecified

State of Use of the Measure

State of Use
Current routine use
Current Use
Accreditation
Decision-making by businesses about health plan purchasing
Decision-making by consumers about health plan/provider choice
External oversight/Medicaid
External oversight/State government program
Internal quality improvement
Pay-for-reporting
Public reporting

Application of the Measure in its Current Use

Measurement Setting
Ambulatory/Office-based Care
Emergency Department
Hospital Outpatient
Managed Care Plans
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Physician Assistants
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Specified
Target Population Age

Age 18 to 64 years

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Prevention and Treatment of Leading Causes of Mortality

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness

Data Collection for the Measure

Case Finding Period

January 1 to December 24 of the measurement year

Denominator Sampling Frame
Enrollees or beneficiaries
Denominator (Index) Event or Characteristic
Clinical Condition
Encounter
Patient/Individual (Consumer) Characteristic
Denominator Time Window
Time window brackets index event
Denominator Inclusions/Exclusions

Inclusions
Health plan members 18 years of age as of January 1 of the year prior to the measurement year to 64 years of age as of December 31 of the measurement year, with a Negative Medication History, a Negative Comorbid Condition History and a Negative Competing Diagnosis, who had an outpatient visit (Outpatient Value Set), an observation visit (Observation Value Set) or an emergency department (ED) visit (ED Value Set) with any diagnosis of acute bronchitis (Acute Bronchitis Value Set) during the Intake Period

Note:

  • Members must have been continuously enrolled one year prior to the Episode Date through 7 days after the Episode Date (inclusive).
  • Allowable Gap: No more than one gap in continuous enrollment of up to 45 days is permitted from 365 days prior to through 7 days after the Episode Date (commercial). To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage.
  • Episode Date: The date of service for any outpatient or ED visit during the Intake Period with any diagnosis of acute bronchitis.
  • Intake Period: January 1 to December 24 of the measurement year. The Intake Period captures eligible episodes of treatment.
  • Negative Medication History: To qualify for Negative Medication History, the following criteria must be met:
    • A period of 30 days prior to the Episode Date, during which time the member had no pharmacy claims for either new or refill prescriptions for a listed antibiotic drug.
    • No prescriptions filled more than 30 days prior to the Episode Date that are active on the Episode Date (refer to Table AAB-D in the original measure documentation for a list of antibiotic medications).
  • A prescription is considered active if the "days supply" indicated on the date the member filled the prescription is the number of days or more between that date and the relevant service date. The 30-day look back period for pharmacy data includes the 30 days prior to the Intake Period.
  • Negative Comorbid Condition History: A period of 12 months prior to and including the Episode Date, when the member had no claims/encounters containing either a principal or secondary diagnosis for a comorbid condition.
  • Negative Competing Diagnosis History: A period of 30 days prior to through 7 days after the Episode Date (inclusive), when the member had no claims/encounters with any competing diagnosis.

Refer to the original measure documentation for steps to identify the eligible population.

Exclusions

  • Do not include ED visits that result in an inpatient admission.
  • Test for Negative Comorbid Condition History. Exclude Episode Dates when the member had a claim/encounter with a diagnosis for a comorbid condition during the 12 months prior to or on the Episode Date. A code from any of the following meets criteria for a comorbid condition:
    • HIV Value Set
    • Malignant Neoplasms Value Set
    • Emphysema Value Set
    • COPD Value Set
    • Cystic Fibrosis Value Set
    • Comorbid Conditions Value Set
  • Test for Negative Medication History. Exclude Episode Dates where a new or refill prescription for an antibiotic medication was filled 30 days prior to the Episode Date or was active on the Episode Date (refer to Table AAB-D in the original measure documentation).
  • Test for Negative Competing Diagnosis. Exclude Episode Dates where during the period 30 days prior to the Episode Date through 7 days after the Episode Date (inclusive) the member had a claim/encounter with any competing diagnosis. A code from either of the following meets criteria for a competing diagnosis:
    • Pharyngitis Value Set
    • Competing Diagnosis Value Set
Exclusions/Exceptions
Medical factors addressed
Numerator Inclusions/Exclusions

Inclusions
Dispensed a prescription for antibiotic medication (refer to Table AAB-D in the original measure documentation for a list of antibiotic medications) on or three days after the Index Episode Start Date (IESD)

Note:

  • This measure is reported as an inverted rate (1 - [numerator/eligible population]). A higher rate indicates appropriate treatment of adults with acute bronchitis (i.e., proportion for whom antibiotics were not prescribed).
  • IESD: The earliest Episode Date during the Intake Period that meets all of the following criteria:
    • 30-day Negative Medication History prior to the Episode Date.
    • A 12-month Negative Comorbid Condition History prior to and including the Episode Date.
    • A Negative Competing Diagnosis during the 30 days prior to the Episode Date through 7 days after the Episode Date (inclusive).
    • The member was continuously enrolled one year prior to the Episode Date through 7 days after the Episode Date.

Exclusions
Unspecified

Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Pharmacy data
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure

Unspecified

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Analysis by subgroup (stratification by individual factors, geographic factors, etc.)
Description of Allowance for Patient or Population Factors

This measure requires that results are reported separately for the commercial and Medicaid product lines.

Standard of Comparison
External comparison at a point in, or interval of, time
External comparison of time trends
Internal time comparison

Identifying Information

Original Title

Avoidance of antibiotic treatment in adults with acute bronchitis (AAB).

Measure Collection Name
Measure Set Name
Measure Subset Name
Submitter
National Committee for Quality Assurance - Health Care Accreditation Organization
Developer
National Committee for Quality Assurance - Health Care Accreditation Organization
Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

Financial Disclosures/Other Potential Conflicts of Interest

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

Endorser
National Quality Forum
NQF Number
0058
Date of Endorsement

2013 Jan 07

Measure Initiative(s)
Physician Quality Reporting System
Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC
2013 Sep
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: National Committee for Quality Assurance (NCQA). HEDIS 2013: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2012. various p.

Source(s)
National Committee for Quality Assurance (NCQA). HEDIS 2014: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2013. various p.

National Committee for Quality Assurance (NCQA). HEDIS 2014: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2013. various p.
Measure Availability

The individual measure, "Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)," is published in "HEDIS 2014. Healthcare Effectiveness Data and Information Set. Vol. 2, Technical Specifications for Health Plans."

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

Companion Documents

The following is available:

  • National Committee for Quality Assurance (NCQA). Improving quality and patient experience. The state of health care quality 2013. Washington (DC): National Committee for Quality Assurance (NCQA); 2013 Oct. 203 p.

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI on June 6, 2006. The information was not verified by the measure developer.

This NQMC summary was updated by ECRI Institute on November 15, 2007. The information was not verified by the measure developer.

This NQMC summary was updated by ECRI Institute on March 10, 2009. The information was verified by the measure developer on May 29, 2009.

This NQMC summary was updated by ECRI Institute on January 15, 2010 and on February 16, 2011.

This NQMC summary was retrofitted into the new template on June 29, 2011.

This NQMC summary was updated by ECRI Institute on May 16, 2012, April 1, 2013, and again on January 10, 2014.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For detailed specifications regarding the National Committee on Quality Assurance (NCQA) measures, refer to HEDIS Volume 2: Technical Specifications for Health Plans, available from the NCQA Web site at www.ncqa.org External Web Site Policy.

Disclaimer

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

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