HEDIS® Tip Sheet

Appropriate Treatment for Upper Respiratory Infection (URI)

Line of business: BlueAlliance (Commercial) & BlueAlliance Care+ (Medicaid)

Measure Description

Percentage of episodes for members 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.

Measure Definitions

  • Intake Period: Captures eligible episodes of treatment for URI between July 1 of the year prior to the measurement year to June 30 of the measurement year.
  • Episode Date: The date of service in any outpatient setting with a diagnosis of upper respiratory infection. 
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Notes

  • This measure is reported as an inverted rate, so a higher rate indicates appropriate URI treatment.
    • Compliance for this measure includes events that did not result in an antibiotic being dispensed on or 3 days after the episode date
  • If a member has more than one eligible episode in a 31-day period, only the first eligible episode is included.
  • Include members who had an outpatient visit, ED visit, telephone visit, or telehealth visit for a diagnosis of an upper respiratory infection.
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Best Practices

  • Realtime bedside education regarding use of antibiotics.
  • Educate patients regarding difference between bacterial vs. viral.
  • Educate patients on how to treat symptoms at home without antibiotics.  The CDC has a ‘Symptom Relief Prescription Pad’ which can be downloaded from the cdc.gov. Symptom Relief for Viral Illnesses (cdc.gov) .
  • Engage in the Choosing Wisely campaign.
  • Provide consistent messaging in treatment rooms, website, and social media platforms regarding appropriate antibiotic use.
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Exclusions

  • Visits that result in an inpatient stay.
  • Members in hospice during the measurement year.
  • Members who died during the measurement year. 

Antibiotic Medications for URI



Coding Disclaimer

The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.

Questions  

Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.

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