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Johns Hopkins Health Plans

AAB - Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis

Product Lines:
Advantage MD, EHP, Priority Partners and USFHP.

Measurement Period: January 1 - December 31

Description:
The percentage of episodes for persons 3 months of age and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.

Stratifications: 
Age as of the episode date.

  • 3 months–17 years
  • 18–64 years
  • 65 years and older

Measure Reporting: HealthChoice Performance Measure reporting for Priority Partners.

Improvement Notation: Increased score indicates improvement.

Note: Reported as an inverted rate [1-(numerator/denominator)].

A higher rate indicates appropriate acute bronchitis/bronchiolitis treatment (i.e., the proportion for episodes that did not result in an antibiotic dispensing event).

Data Collection:

  • Administrative

Note: Supplemental data may not be used for this measure, except for denominator exclusions.

Initial Population:

  • Measure Item Count: Episode
  • Age: 3 months of age or older as of the episode date
  • Benefits: Medical and pharmacy
  • Continuous Enrollment: 30 days prior to the episode date through 3 days after the episode date (34 days total)
  • Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Definition: 
Episode date: The date of service for any outpatient, telephone or ED visit, e-visit or virtual check-in during the intake period with a diagnosis of acute bronchitis/bronchiolitis.

Intake period: July 1 of the year prior to the measurement period to June 30 of the measurement period. The intake period captures eligible episodes of treatment.

Negative comorbid condition history: A period of 365 days prior to and including the episode date when the person had no claims/encounters with any diagnosis for a comorbid condition (366 total days).

Negative competing diagnosis: The episode date and 3 days following the episode date when the person had no claims/encounters with any competing diagnosis. 
Negative medication dispensed history: To qualify for negative medication history, the following criteria must be met:

  • A period of 30 days prior to the episode date when the person had no pharmacy claims for either new or refill prescriptions for a listed antibiotic drug.
  • No prescriptions dispensed more than 30 days prior to the episode date that are active on the episode date.

A prescription is considered active if the “days supply” indicated on the date when the person was dispensed the prescription is the number of days or more between that date and the relevant service date. The 30-day look-back period for pharmacy data includes the 30 days prior to the intake period.

Denominator:
Episodes of acute bronchitis/bronchiolitis diagnosis.
Persons who had an outpatient, ED, telephone or e-visit or virtual check-in visit during the intake period with a diagnosis of acute bronchitis/bronchiolitis.
Note: The measure is based on episodes; therefore, it is possible for the denominator to include multiple events for the same person. If a person has more than one eligible episode in a 31-day period, only the first eligible episode will be included.

Numerator:
Antibiotic medication was dispensed.
Dispensed prescription for an antibiotic medication on or 3 days after the episode date.

 

Best Practice and Measure Tips

  • Avoid prescribing an antibiotic unless there is a bacterial etiology.
  • When antibiotics are needed for a patient with acute bronchitis / bronchiolitis with comorbid conditions: submit codes on the same claim to remove member from measure.
    • Examples:  HIV, Malignant Neoplasm, Emphysema, COPD 
  • An episode will not count toward the measure denominator if the member was diagnosed with pharyngitis or a competing diagnosis, if the visit resulted in an inpatient stay on or 3 days after the episode date.
  • Not exclusions for this HEDIS measure: asthma and diabetes diagnosis; Symptoms such as fever, cough and wheezing; tobacco use.
  • This measure is based on episodes; members may have multiple episodes. 
  • CDC offers a number of materials and tools about antibiotic resistance, appropriate prescribing and use for common infections.
  • Telehealth visits are allowed for this measure.  

Measure Exclusions

Denominator Exclusions:

  • Persons in hospice or using hospice services any time during the measurement period.  
  • Persons who died any time during the measurement period. 
  • Exclude visits that result in an inpatient stay.
  • Episode dates where the person had a claim/encounter with any diagnosis for a comorbid condition during the 365 days prior to or on the episode date.
  • Episode dates where a new or refill prescription for an antibiotic medication was dispensed 30 days prior to the episode date or was active on the episode date.
  • Episode dates where the person had a claim/encounter with a competing diagnosis  on or three days after the episode date.

Exclusion Codes

Comorbid Conditions

  • ICD-10-CM: A15.0, A17.0, A18.01, A19.0, B44.81, D57.01, D61.810, D70.0, D71, D72.0, D75.81, D76.1, D86.0, E84.0, J22, J41.0, J42, J47.0, J60, J61, J62.0, J63.0, J64, J65, J66.0, J67.0, J68.0, J69.0, J70.0, J80, J81.0, J82, J84.01, J85.0, J86.0, J90, J91.0, J92.0, J93.0, J94.0, J95.00, J95.01, J96.00, J98.51, J99, M05.10, M30.1, M32.13, M33.01, M34.81, M35.02, O98.011, P27.0, Q25.45, Q30.0, Q31.0, Q32.0, Q33.0, Q34.0, Q34.1, Q39.0, Q89.01*

Competing Diagnosis

  • ICD-10-CM: A00.0, A02.0, A03.0, A04.0, A05.0, A06.0, A07.0, A08.0, A09, A37.00, A44.0, A50.01, A54.00, A55, A56.00, A57, A58, A59.00, A59.9, A63.0, A64, A69.0, A69.9, B60.0, B64, B78.1, B96.89, E83.2, H66.001, H67.1, H70.001, H95.00, J01.00, J04.10, J05.0, J13, J14, J15.0, J16.0, J17, J18.0, J20.0, J32.0, J35.01, J38.7, J39.0, K05.20, K12.2, L01.00, L03.011, L04.0, L08.1, L92.8, L98.0, M46.20, M89.00, M90.80, N10, N12, N13.0, N15.1, N16, N30.00, N39.0, N41.0, N70.01, N71.0, N72, N73.0, N74, N75.0, N76.0, N77.0, Z20.2, Z22.4*

Pharyngitis

  • ICD-10-CM: J02.0, J02.8, J02.9, J03.00, J03.01, J03.80, J03.81, J03.90, J03.91
    *Please note that not all ICD-10-CM and SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to Comorbid Conditions and Competing Diagnosis Value Set, contact your Provider Engagement Liaison or email [email protected].
     

 

Measure Codes

Diagnosis of acute bronchitis/bronchiolitis:

  • ICD-10-CM: J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9, J21.0, J21.1, J21.8, J21.9 
  • SNOMED CT US Edition: 718004, 5505005, 5875001, 10509002, 15199004, 35301006, 80257001, 195714005, 195717003, 195725001, 195726000, 195727009, 195728004, 195729007, 195737004, 195739001, 196020005, 233601004, 233602006, 233603001, 275495004, 312371005, 312400008, 445102008, 714203003, 735464006, 785745000, 138389411000119105

Measure Medications

To comply with this measure, episode dates will not count where a new or refill prescription for an antibiotic medication (AAB Antibiotic Medications List) was dispensed 30 days prior to the episode date or was active on the episode date. Otherwise, a dispensed prescription for any of the medication below on or 3 days after the episode date, will count.

AAB Antibiotic Medications List

  • Amikacin
  • Amoxicillin
  • Amoxicillin-clavulanate
  • Ampicillin
  • Ampicillin-sulbactam
  • Azithromycin
  • Aztreonam
  • Cefaclor
  • Cefadroxil
  • Cefazolin
  • Cefdinir
  • Cefepime
  • Cefixime
  • Cefotaxime
  • Cefotetan
  • Cefoxitin
  • Cefpodoxime
  • Cefprozil
  • Ceftazidime
  • Ceftriaxone
  • Cefuroxime
  • Cephalexin
  • Chloramphenicol
  • Ciprofloxacin
  • Clarithromycin
  • Clindamycin
  • Dalfopristin-quinupristin
  • Daptomycin
  • Dicloxacillin
  • Doxycycline
  • Erythromycin
  • Fosfomycin
  • Gemifloxacin
  • Gentamicin
  • Levofloxacin
  • Lincomycin
  • Linezolid
  • Metronidazole
  • Minocycline
  • Moxifloxacin
  • Nafcillin
  • Nitrofurantoin
  • Nitrofurantoin, macrocrystals-nitrofurantoin, nonohydrate
  • Ofloxacin
  • Oxacillin
  • Penicillin G benzathine
  • Penicillin G benzathine-penicillin G Procaine
  • Penicillin G potassium
  • Penicillin G procaine
  • Penicillin G sodium
  • Penicillin V potassium
  • Piperacillin-tazobactam
  • Rifampin
  • Streptomycin
  • Sulfadiazine
  • Sulfamethoxazole-trimethoprim
  • Tetracycline
  • Tobramycin
  • Trimethoprim
  • Vancomycin