This article series is our monthly tool to help you maximize patient healthoutcomes in accordance with NCQA?s¹ HEDIS^®2 measurements for highquality care on important dimensions of services.

HEDIS^® definitions

• Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis(AAB): The percentage of Commercial and Medicaid members 18 to64 years with a diagnosis of AAB who were not dispensed an antibioticprescription within three days of visit date.
• Appropriate Treatment for Children with upper respiratory infection(URI): The percentage of children 3 months to 18 years who were given adiagnosis of URI and were not dispensed an antibiotic prescription withinthree days of visit date.

Educational resources

Educating your patients on the proper usage of antibiotics and thelong-term risks of antibiotic resistance is critical to improving thesemeasures. To help, here are links to resources from the Centers for DiseaseControl and Prevention (CDC) for you and your patients:

• For providers: www.cdc.gov/getsmart/campaign-materials/treatment-guidelines.html
• For patients: www.cdc.gov/getsmart/specific-groups/everyone.html

Quick tips for improvement

• ✔ The 3-Day Rule: Follow up with patients three days after the initial visitto discuss treatment options if symptom relief has not occurred.
• ✔ The Poster Board Pledge: Recent studies have shown that displayingposter-sized commitment letters in exam rooms to avoid inappropriateantibiotic prescribing was a simple, low-cost, and effective method forimprovement. ? JAMA Internal Medicine
• ✔ Coding 101: If your patient has comorbidities, bacterial infections, orcompeting diagnoses, the standard codes for AAB and URI may not beapplicable.

QIPS³ Alert!

These two measures areincluded in the QualityIncentive Payment System(QIPS) program formeasurement year 2014for participating providers:

• Avoidance of antibiotic treatment in adults with acute bronchitis;
• Appropriate treatmentfor children with upperrespiratory infection.

Send us your feedback

If you have feedback about the Highlighting HEDIS^® series or you havetopic ideas, please email us at provider_communications@ibx.com.

Go to our Highlighting HEDIS^® web page for more Highlighting HEDIS^® topics.

¹ The National Committee for Quality Assurance (NCQA) is the most widely recognizedaccreditation program in the U.S.

² The Healthcare Effectiveness Data and Information Set (HEDIS) is an NCQA tool used bymore than 90 percent of U.S. health plans to measure performance on important dimensionsof care.

³ The Quality Incentive Payment System (QIPS) is a reimbursement system developed byKeystone Health Plan East for participating Pennsylvania primary care physicians that offersincentives for high-quality, accessible, and cost-effective care.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.