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

Eligible Population:
Members 3 months and older by December 31 of the measurement year.

Definition:
Percentage of episodes for members ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis, who were not dispensed an antibiotic medication on or 3 days after the episode. Looks at episodes for any outpatient, telephone, observation or ED visit, e-visit or virtual check-in during the intake period with a diagnosis of acute bronchitis/bronchiolitis, between July 1 of the year prior to the measurement year through June 30 of the measurement year. The measure is reported as an inverted rate: A higher rate indicates appropriate treatment (not prescribed an antibiotic).

Report three age stratifications and a total rate: 

• 3 months–17 years. 
• 18–64 years.
• 65 years and older. 
• Total. The total is the sum of the age stratifications. 

Continuous Enrollment:

• 30 days prior to the episode date through 3 days after the episode date (34 total days).

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.
  • Permission is not needed to print, copy, or distribute any materials. Visit the CDC website.
• Telehealth visits are allowed for this measure.  

Measure Exclusions

• Members in hospice or using hospice services anytime during the measurement year.  
• Members who died any time during the measurement year. 

Measure Codes

Diagnosis of acute bronchitis/bronchiolitis (Acute Bronchitis Value Set): J20.3-J20.9, J21.0, J21.1, J21.8, J21.9 

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 below medication on or 3 days after the episode date, will count.