Continuous Improvement and the Expansion of Quality ... - NCQA

Recommendations

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• fall Risk Management • Management of Urinary Incontinence in older Adults • osteoporosis Testing in older Adults • Physical Activity in older Adults. terms T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E 25 NA: Measure rates have no available data. In some instances, data are not collected for a measure in a product line. Rate: The statistical mean for reported data. Each measure is described by an average rate for each applicable product line. a note on Medicare survey data Medicare CAHPS survey data of consumer experience and HEDIS measures collected through the survey (such as flu Shots for Adults and Medical Assistance With Smoking and Tobacco Use Cessation) are not available when NCQA prints the State of Health Care Quality Report in September. NCQA will issue an updated version of this report that includes those data in November.
S A f E T y A N D P o T E N T I A l W A S T E 26 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E AVoIDANCE of ANTIbIoTIC TREATMENT IN ADUlTS WITH ACUTE bRoNCHITIS Acute bronchitis clinically presents as a cough lasting more than five days (typically, from one to three weeks). About 90 percent of cases are caused by a virus. 1,2 The Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis measure evaluates whether adults were treated appropriately by not receiving antibiotics, which are not indicated and may contribute to antibiotic resistance. • Acute bronchitis affects approximately 5 percent of U.S. adults annually and continues to rank among the top 10 conditions for which patients seek treatment in clinical settings. 1 • Antibiotics are prescribed in more than 60 percent of bronchitis cases; of those, 80 percent were unnecessary, according to the Centers for Disease Control and Prevention (CDC) guidelines. 1,2 Antibiotic treatment is not usually appropriate for acute bronchitis, with the exception of comorbid diseases requiring antibiotics. 3 the Case for Improvement • More than $1.1 billion is spent annually on unnecessary antibiotics for respiratory infections in adults. 4 • Treating drug-resistant pathogens poses a significant burden on the system through repeated health care visits and greater risk of disease complications and hospitalizations—which lead to increased health care costs. 5,6 • Diminished effectiveness of antibiotics against bacterial infections, particularly for use in patients who may need them to fight future, life-threatening bacterial infections, poses a significant public health concern. When resistance makes widelyused antibiotics ineffective, an alternative treatment may not be available, 7 or physicians may use more potent antibiotics, which are often more toxic and more expensive. This can result in longer hospital stays, more serious side effects and increased financial burden on the system and on patients. 8 HEdIs Measure definition This measure assesses the percentage of adults 18–64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription on or three days after an episode. A higher rate indicates better performance.
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128 N AT I o N A l C o M M I T T E
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130 APPENDIx 1: HEDIS EffECTIVENESS
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134 APPENDIx 2: HEDIS EffECTIVENESS
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158 APPENDIx 8: PUblICly REPoRTING
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172 MEASURE N AT I o N A l C o M M
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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