Description:


The percentage of children 2–18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e., appropriate testing).



Denominator:


Product lines
Commercial, Medicaid (report each product line separately).
Ages
Children 2 years as of July 1 of the year prior to the measurement year to 18 years as of June 30 of the measurement year.
Continuous enrollment
30 days prior to the Episode Date through 3 days after the Episode Date (34 total days).
Allowable gap
No gaps in enrollment during the continuous enrollment period.
Anchor date
Episode Date.
Benefits
Medical and pharmacy.
Event/ diagnosis
Outpatient or ED visit with only a diagnosis of pharyngitis and a dispensed antibiotic for that episode of care during the Intake Period.
Follow the steps below to identify the eligible population.

Step 1

Identify all members who had an outpatient visit (Outpatient Value Set), an observation visit (Observation Value Set) or an ED visit (ED Value Set) during the intake period, with only a diagnosis of pharyngitis (Pharyngitis Value Set).
Exclude claims/encounters with more than one diagnosis and ED visits that result in an inpatient admission.

Step 2

Determine all pharyngitis Episode Dates. For each member identified in step 1, determine all outpatient or ED claims/encounters with only a diagnosis of pharyngitis.

Step 3

Determine if antibiotics (Table CWP-C) were dispensed for any of the Episode Dates. For each Episode Date with a qualifying diagnosis, determine if antibiotics were dispensed on or up to three days after. Exclude Episode Dates if the member did not receive antibiotics on or three days after the Episode Date.



Table CWP-C: Antibiotic Medications

Description
Prescription
Aminopenicillins
Amoxicillin
Ampicillin
Beta-lactamase inhibitors
Amoxicillin-clavulanate
First generation cephalosporins
Cefadroxil
Cefazolin
Cephalexin
Folate antagonist
Trimethoprim

Lincomycin derivatives
Clindamycin

Macrolides
Azithromycin
Clarithromycin
Erythromycin
Erythromycin ethylsuccinate
Erythromycin lactobionate
Erythromycin stearate
Miscellaneous antibiotics
Erythromycin-sulfisoxazole

Natural penicillins
Penicillin G potassium
Penicillin G sodium
Penicillin V potassium
Penicillinase-resistant penicillins
Dicloxacillin

Quinolones
Ciprofloxacin
Levofloxacin
Moxifloxacin
Ofloxacin
Second generation cephalosporins
Cefaclor
Cefprozil
Cefuroxime
Sulfonamides
Sulfamethoxazole-trimethoprim
 
Tetracyclines
Doxycycline
Minocycline
Tetracycline
Third generation cephalosporins
Cefdinir
Cefixime
Cefpodoxime
Ceftibuten
Cefditoren
Ceftriaxone

Note: NCQA will post a comprehensive list of medications and NDC codes to www.ncqa.org
by November 2, 2015.

Step 4

Test for Negative Medication History. Exclude Episode Dates where a new or refill prescription for an antibiotic medication (Table CWP-C) was filled 30 days prior to the Episode Date or where a prescription filled more than 30 days prior to the Episode Date was active on the Episode Date.

Step 5

Calculate continuous enrollment. The member must be continuously enrolled without a gap in coverage from 30 days prior to the Episode Date through 3 days after the Episode Date (34 total days).

Step 6 

Select the IESD. This measure examines the earliest eligible episode per member.


Numerator:

A group A streptococcus test (Group A Strep Tests Value Set) in the seven-day period from three days prior to the IESD through three days after the IESD.