Brief Description of Measure:
​CMS146: Appropriate Testing for Pharyngitis

The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test

CMS154: Appropriate Treatment for Upper Respiratory Infection (URI)

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

Description of Issue:
Currently, the logic for the denominator exclusions does not include medications that were active in the full 30 days prior to the encounter, or medications that were active prior to the encounter date and still active on the encounter date. However, this is the intent of this exclusion, and how the current measure language found in the header is written.

Proposed Solution:

​We propose updating the logic to allow for a full 30 days prior to the encounter date to look for the active medication, and include new logic to include medications that were started prior to the encounter date and are still active on the day of the encounter.

CMS 146:
Current logic:
Encounter With Antibiotic Active In 30 Days Prior
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic
such that Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps Interval[Global."ToDate" ( ( start of EncounterWithPharyngitis.relevantPeriod ) - 30 days ), Global."ToDate" ( start of EncounterWithPharyngitis.relevantPeriod )]
return EncounterWithPharyngitis

Proposed logic:
define "Encounter With Antibiotic Active In 30 Days Prior Or The First Day of the Encounter":
"Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic
such that ( Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps day of Interval[start of EncounterWithPharyngitis.relevantPeriod - 31 days, start of EncounterWithPharyngitis.relevantPeriod - 1 day]
or Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps before day of Interval[start of EncounterWithPharyngitis.relevantPeriod,
end of EncounterWithPharyngitis.relevantPeriod]
)
return EncounterWithPharyngitis

CMS 154:
Current logic:
Encounter with Upper Respiratory Infection and Antibiotics Active 30 Days Prior

"Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic
such that Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps Interval[Global."ToDate" ( ( start of EncounterWithURI.relevantPeriod ) - 30 days ), start of EncounterWithURI.relevantPeriod]
return EncounterWithURI

Proposed logic:
Encounter with Upper Respiratory Infection and Antibiotics Active 30 Days Prior Or The First Day Of The Encounter

Encounter with Upper Respiratory Infection" EncounterWithURI
with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic
such that (Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps day of Interval[ start ofEncounterWithURI.relevantPeriod ) - 31 days , start of EncounterWithURI.relevantPeriod – 1 day]
or Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps before day of Interval[start of EncounterWithURI.relevantPeriod,
end of EncounterWithURI.relevantPeriod] )
return EncounterWithURI

Rationale for Change:
​This correction will align both measures with the intent of the denominator exclusion.