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

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yEAR 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 WItHIn 7 days Post-dIsCHargE CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 59.7 54.2 37.4 39.1 44.6 2009 58.7 52.6 37.3 40.6 42.9 2008 57.2 49.8 38.1 37.3 42.6 2007 55.6 41.9 37.0 33.3 42.5 2006 56.7 48.3 36.9 38.5 39.1 2005 55.8 49.9 39.2 47.1 39.2 2004 55.9 NA 40.1 NA 38.0 2003 54.4 NA 38.8 NA 37.7 2002 52.7 NA 38.7 NA 37.2 2001 51.3 NA 37.2 NA 33.2 2000 48.2 NA NA NA NA 1999 47.4 NA NA NA NA WItHIn 30 days Post-dIsCHargE yEAR 83 CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 77.4 74.1 55.4 61.2 63.8 2009 76.8 72.1 54.8 60.5 60.2 2008 76.1 71.4 56.5 55.5 61.7 2007 74.0 63.4 54.4 50.2 61.0 2006 75.8 68.1 56.3 58.3 57.7 2005 75.9 70.7 59.4 60.1 56.8 2004 75.9 NA 60.7 NA 54.9 2003 74.4 NA 60.3 NA 56.4 2002 73.6 NA 60.6 NA 56.7 2001 73.2 NA 60.6 NA 52.2 2000 71.2 NA NA NA NA 1999 70.1 NA NA NA NA 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
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 84 over the last 10 years, the Centers for Disease Control and Prevention (CDC) have increased efforts to prevent the misuse of antibiotics to treat respiratory infections, particularly pharyngitis. Pharyngitis, or sore throat, is common in children and adolescents and can be caused by a bacteria or virus. 1 The Appropriate Testing for Children With Pharyngitis measure evaluates whether children are properly treated for pharyngitis after undergoing diagnostic testing, thereby avoiding the build-up of antibiotic resistance. • Pharyngitis affects a large number of individuals and is responsible for 12 million primary care visits each year in the U.S. 2 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 TESTING foR CHIlDREN WITH PHARyNGITIS • The bacteria most commonly associated with pharyngitis (Group A streptococcus) is responsible for up to 30 percent of pharyngitis cases in children. 3 In winter and early spring, up to 15 percent of school-age children may carry the bacteria without displaying symptoms. 4 the Case for Improvement • Pharyngitis has a significant financial burden on children and adults alike, costing an estimated $224 million– $539 million and resulting in 1,300 deaths every year. 5 • Pharyngitis often is overdiagnosed. While there are differing opinions on performing rapid antigen detection testing (RADT) and throat cultures, clinical guidelines strongly recommend performing a diagnostic test or a throat culture before treatment. 6 • Infections resulting from pharyngitis can have lifestyle and productivity effects. one study found that both children and parents missed a notable number of school and work days because of pharyngitis-related treatment and management. 7 HEdIs Measure definition The percentage of children 2–18 years of age who were diagnosed with pharyngitis and dispensed an antibiotic, and who also received a group A streptococcus test for the episode. A higher rate represents better performance (i.e., appropriate testing). results Antibiotic treatment is only infrequently appropriate for pharyngitis. The availability of RADT has made it easier to perform diagnostics, thereby potentially reducing antibiotic use and preventing the spread of drug-resistant strains of pharyngitis. 8
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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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