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

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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 results Research suggests that treatment reduces drug use, improves health and job performance, reduces involvement with the criminal justice system, reduces family dysfunction and improves quality of life. 3,7 yEAR EngagEMEnt CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 15.6 16.0 3.7 4.8 14.2 2009 16.1 15.7 4.6 4.2 12.3 2008 16.2 16.2 4.3 9.4 12.4 2007 15.2 15.2 4.5 6.3 14.4 2006 13.8 16.0 4.5 7.0 11.7 2005 14.1 15.3 4.7 3.2 9.7 2004 15.5 NA 7.1 NA 11.9 yEAR InItIatIon 71 CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 42.7 40.8 44.6 57.4 42.9 2009 42.7 41.8 46.2 57.4 44.3 2008 42.4 42.6 45.9 49.1 44.5 2007 44.5 46.0 50.4 56.5 45.6 2006 43.2 49.0 50.3 50.0 43.3 2005 44.5 45.8 50.9 52.3 40.7 2004 45.9 NA 52.6 NA 45.7 C H R o N I C D I S E A S E M A N A G E M E N T
M E A S U R E S T A R G E T E D A T C H I l D R E N A N D A D o l E S C E N T S 72 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 APPRoPRIATE TREATMENT foR CHIlDREN WITH UPPER RESPIRAToRy INfECTIoN Upper respiratory infections (URI) are self-regulating viral infections that cannot be treated by antibiotics. 1 Despite this, clinical practice trends show that antibiotics are often prescribed, leading to a trend in overuse and growing antimicrobial resistance among patients. 1 Also known as the “common cold,” URIs target the lining of the throat and nose, resulting in fever, congestion, coughing and other symptoms. 2 The Appropriate Treatment for Children With Upper Respiratory Infection measure evaluates whether children were properly treated for URIs by not receiving antibiotics unless deemed appropriate by a clinician. • Approximately over 100 million antibiotic prescriptions are written in the ambulatory care setting every year. 3 • According to the Centers for Disease Control and Prevention, antibiotics were prescribed during 68 percent of URI visits. of these visits, 80 percent did not require the prescription of antibiotics as defined by practice guidelines. 4 • In 2005, there were 1.17 billion visits to ambulatory clinics and emergency departments. 11 percent (130 million visits) were for acute respiratory infections. 7 the Case for Improvement • In the U.S., URIs are responsible for nearly $17 billion in direct costs (e.g., physician services and treatment because of complications) and $22.5 billion in indirect costs (e.g., absenteeism and lost productivity) every year. 6 • Studies have shown that up to 60 percent of patients with colds or URIs seen in the emergency department are prescribed antibiotics, which have not demonstrated improvement in clinical outcomes. 5 • overuse of antibiotics is a significant issue in URI treatment. A survey conducted in 2004 illustrated that among children seen in a primary practice, outpatient or emergency department setting, those diagnosed with viral URIs experienced even higher rates of antibiotic prescription, even though antibiotics are ineffective for treating viral infections. 8
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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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182 APPENDIx 16b: VARIATIoN IN PlAN
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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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