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  1. eCQM Issue Tracker
  2. CQM-572

Appropriate Treatment for Children with URI: Is each episode counted in the denominator?

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    • Icon: Intent/Governance affecting more than 1 eCQM Intent/Governance affecting more than 1 eCQM
    • Resolution: Answered
    • Icon: Minor Minor
    • Measure
    • How to treat patients who have multiple valid episodes of URI, should each episode count separately or should a patient only be included once?
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      This is an episode-based measure, which means that in the denominator you include all episodes of URI across all patients, and your numerator is the number of episodes with a strep A test. In the example below, the denominator would be 3 and the numerator would be two.

      If you had another patient with three episodes and all three met the numerator, and added this patient to the existing patient, your denominator is six, and your numerator is five.

      NOTE: HQMF R2.1 adds the ability to identify the items to count in a machine processable format (rather than textual guidance). This change to the HQMF will solve the underlying issue that led to this problem. This change will be available in the next measure versions published but cannot be fixed for the measures published in 2014.
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      This is an episode-based measure, which means that in the denominator you include all episodes of URI across all patients, and your numerator is the number of episodes with a strep A test. In the example below, the denominator would be 3 and the numerator would be two. If you had another patient with three episodes and all three met the numerator, and added this patient to the existing patient, your denominator is six, and your numerator is five. NOTE: HQMF R2.1 adds the ability to identify the items to count in a machine processable format (rather than textual guidance). This change to the HQMF will solve the underlying issue that led to this problem. This change will be available in the next measure versions published but cannot be fixed for the measures published in 2014.

      We would like clarification on how to determine the denominator for CMS154 Appropriate Treatment for Children with Upper Respiratory Infection (URI).

      • Denominator (which is identical to the Initial Patient Population) criteria states: Children age 3 months to 18 years who had an outpatient or emergency department (ED) visit with a diagnosis of upper respiratory infection (URI) during the measurement period.
      • Guidance states: This measure examines all episodes per patient during the measurement period.

      FOR EXAMPLE: If a single patient has three (3) episodes of URI diagnosis that meet all denominator criteria, and only two (2) of those episodes had a Strep A test conducted 3 days before or after the episode [the satisfaction criteria for the numerator], how should this be reported?

      Is the denominator 3, and the numerator 2 (Thus a 67% performance rate)

      OR Is the denominator 1, and the numerator 0, since we want to evaluate all episodes and not all of the patients episodes meet the numerator criteria. (Thus a 0% performance rate)

      OR something else?

      Thank you,
      Samantha Wang

            j44y carol (Inactive)
            swang Samantha Wang (Inactive)
            Minet Javellana (Inactive), Samantha Wang (Inactive)
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