Provider News (Winter 2008)
Upper respiratory infection and pharyngitis
Appropriate treatment of children, age 3 months to 18 years, with an upper respiratory infection (URI) showed Security Health Plan had a 80.6% rate for the most recent HEDIS review. This HEDIS measure looks at the percentage of children who were given a diagnosis of upper respiratory infection and were not dispensed an antibiotic prescription on, or within three days of, the date of service. When doing an analysis of patients not meeting this measure, many times the medical record supported a different diagnosis (pharyngitis or pneumonia) rather than the upper respiratory infection, which was billed.
Appropriate testing for children, age 2-18 years, with pharyngitis showed a rate of 88.25% in the HEDIS review. This measure looks at the percentage of children who were diagnosed with pharyngitis, dispensed an antibiotic, and received a group A streptococcus test for the date of service.
According to the HEDIS measures:
| Antibiotics are NOT indicated for Upper Respiratory Infections as listed below
| Antibiotics are indicated for a Pharyngitis diagnosis as listed below
|
|---|
| 460 – Acute nasopharyngitis (common cold) | 462 – Acute pharyngitis |
| 465 – URI | 463 – Acute tonsillitis |
| | 034.0 – Streptococcal sore throat |
As you can see, we have room for improvement in both of these HEDIS measures.
