Respiratory Conditions
Appropriate Testing for Children with Pharyngitis
Pharyngitis, or sore throat is one of the most common conditions encountered by the family physician. Acute pharyngitis accounts for 1.1 percent of visits in the primary care setting and is ranked in the top 20 reported primary diagnoses resulting in office visits. A sore throat most often is caused by direct infection of the pharynx, primarily by viruses or bacteria. Antibiotics are needed to treat bacterial pharyngitis, but are not useful for treating viral pharyngitis. Before antibiotics are prescribed, a throat culture needs to be completed to validate bacterial origin. Excessive use of antibiotics for pharyngitis is common, represents unnecessary cost, and contributes to antibiotic resistance.
This measure assesses the percentage of children 2 to 18 years old who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. A higher rate represents appropriate testing.
Many pediatricians and family practitioners use an office-based (rather than laboratory-based) strep test. Office-based tests frequently are not reported to health plans. The pharyngitis testing results may therefore underestimate actual performance.
Appropriate Treatment for Children with Upper respiratory Infection (URI)
Upper respiratory infections (URI), or common colds, are most prevalent among children due to their high contact with other children. Children in day care in the U.S. are estimated to have an URI approximately every 3 weeks from the age of 6 months to 2 years. The incidence decreases at the time of school entry at which time a child has about 3-6 episodes of URI per year. URI's are almost always viral, therefore antibiotics are ineffective.
This HEDIS measures looks at the percentage of children 3 months to 18 years of age who were given a diagnosis of URI and were not dispensed an antibiotic prescription on or within three days after the Episode Date. Excessive use of antibiotics for URI's is common, represents unnecessary cost, and contributes to antibiotic resistance. A higher rate indicates appropriate treatment.
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
In the United States, about 5% of adults self-report an episode of acute bronchitis each year, and up to 90% of these persons seek medical attention. In 1997, adults in the United States made more than 10 million office visits for bronchitis. As a result, acute bronchitis consistently ranks among the 10 conditions that account for most ambulatory office visits to U.S. physicians. Antibiotics are most often inappropriately prescribed in adults with acute bronchitis.
Antibiotics are not indicated in clinical guidelines for the treatment of 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. Despite the fact that the majority of acute bronchitis cases have a nonbacterial cause (greater than 90%), antibiotics are prescribed 65 percent to 80 percent of the time.
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.
Pharmacotherapy Management of COPD Exacerbation
While other major causes of death have been decreasing, chronic obstructive pulmonary disease (COPD) mortality has risen, making it the fourth leading cause of death in the United States. COPD is characterized by airflow limitation that is not fully reversible, is usually progressive and is associated with an abnormal inflammatory response of the lung to noxious particles or gases. COPD defines a group of diseases that includes chronic bronchitis and emphysema, and patients are prone to frequent exacerbations of symptoms that range from chronic cough and sputum production to severe disabling shortness of breath, leading to significant impairment of quality of life.
In addition to being a major cause of chronic disability, COPD is a driver of significant health care service use. The disease results in both high direct and high indirect costs, and exacerbations of COPD account for the great burden on the health care system, though studies have shown that proper management of exacerbations may have the greatest potential to reduce the clinical, social and economic impact of the disease. Pharmacotherapy is an essential component of proper management.
The National Heart, Lung, and Blood Institute (NHLBI) states that over 12 million adults have been diagnosed with chronic obstructive pulmonary disease (COPD) and the actual number of those with the disease may be higher. COPD exacerbation is a change in the patient's baseline dyspnea, cough or sputum that is beyond normal day-to-day variations, is acute in onset and may warrant a change in regular medication in a patient with underlying COPD. Exacerbations may be the most significant drivers of negative impacts on a COPD patient. After an exacerbation, both patient's symptoms and lung function can take several weeks to recover to baseline, and quality of life declines drastically. While there is no cure for COPD, decreasing the frequency of exacerbations may slow its progression, and thus should be a critical goal of management.
Studies show that bronchodilators and systemic corticosteroids are the most ideal treatments for home/outpatient management of exacerbations. Bronchodilators are the foundation of pharmacotherapy for COPD because of their capacity to alleviate symptoms, decrease exacerbations and improve the health status of COPD patients.
This measure is used to access the percentage of COPD exacerbations for members 40 years and older who had an acute inpatient discharge or ED encounter during the measurement year and who were dispensed appropriate medications. It looks at:
- The percent of qualifying members who were dispensed systemic corticosteroid within 14 days of event
- The percent of qualifying members who were dispensed a bronchodilator within 30 days of event
Use of Appropriate Medications for People with Asthma
Asthma is a chronic lung disease and a rapidly growing public health problem. It is the most common chronic respiratory disease in children and can result in life-threatening episodes of illness for both adults and children. Asthma is the leading cause of school absenteeism from a chronic childhood condition. Unfortunately, asthma is becoming more common and currently affects more than 20 million Americans, including almost 9 million children.
The recommended treatment for most patients with persistent asthma emphasizes daily, long-term prevention therapy that improves the underlying airway inflammation. Appropriate preventive treatment can result in fewer episodes of wheezing and coughing and a decrease in the use of medications needed to treat these symptoms. Commonly used preventive medications include anti-inflammatory prescriptions such as inhaled corticosteroids, Cromolyn Sodium and Nedocromil as well as other alternative oral medications.
Measuring whether health plan members with persistent asthma receive the recommended medications for long-term control of their asthma is very important. Because the challenges in accurately diagnosing and caring for children with persistent asthma are very different from the identification and treatment of asthma in adults, separate rates were calculated in those age groups. This measure reports the percentage of members diagnosed with asthma who received appropriate medication management during the measurement year. Four rates are reported: Ages 5 -9, Ages 10 -17, Age 18 -56, and Total.
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world and in the United States. COPD defines a group of diseases characterized by airflow obstruction, and includes chronic bronchitis and emphysema. Symptoms of COPD range from chronic cough and sputum production to severe, disabling shortness of breath, leading to significant impairment of quality of life. COPD afflicts nearly 16 million adults in the United States. COPD is the fourth leading cause of death in the United States, and is projected to move to third place by 2020.
Spirometry is a simple test that measures the amount of air a person can breathe out and the amount of time it takes to do so. Both symptomatic and asymptomatic patients suspected of COPD should have spirometry performed to establish airway limitation and severity. Though several scientific guidelines and specialty societies recommend use of spirometry testing to confirm COPD diagnosis and determine severity of airflow limitation, spirometry tests are largely underutilized.
This measure is used to assess the percentage of health plan members 40 years of age and older with a new diagnosis or newly active chronic obstructive pulmonary disease (COPD) who received appropriate spirometry testing to confirm the diagnosis.
|
