This article series is a monthly tool to help physicians maximize patient health outcomes in accordance with NCQA?s* HEDIS^®† measurements for high quality care on important dimensions of services.

Go to our Highlighting HEDIS^® page to view previously published Highlighting HEDIS^® topics. If you have feedback or would like to request a topic, email us.

HEDIS^® definition

Appropriate testing for children with pharyngitis: The percentage of children ages 2 – 18 who were diagnosed with pharyngitis, dispensed an antibiotic, and received group ?A? streptococcus (strep) test for the episode. A higher rate represents better performance (i.e., appropriate testing).

Why this measure is important

Pharyngitis is the only condition among upper respiratory infections (URI) where diagnosis is validated easily and objectively through administrative and laboratory data, and it can serve as an important indicator of appropriate antibiotic use among all respiratory tract infections. Overuse of antibiotics has been directly linked to the prevalence of antibiotic resistance. Promoting judicious use of antibiotics is important to reducing the prevalence of antibiotic resistance. Pediatric clinical practice guidelines recommend that only children diagnosed with group ?A? streptococcus (strep) pharyngitis, based on appropriate lab tests, be treated with antibiotics. Appropriate testing for group ?A? strep pharyngitis includes a rapid strep assay and/or throat culture.
– NCQA, HEDIS 2015 V1

Plan performance

The chart below shows a five-year trend where improvements in antibiotic prescribing have occurred; however, a substantial number of patients are still receiving inappropriate antibiotic treatment.
–2014 State of Health Care Quality (NCQA)

QIPS^‡ alert

Appropriate testing for children with pharyngitis is a performance measure in the Quality Incentive Payment System (QIPS) program for measurement year 2015 for participating providers.

Quick tips for improvement

Only about 30 percent of all cases of pharyngitis in children are caused by bacteria. Be sure to follow the pediatric guidelines for appropriate treatment.
? 2014 State of Health Care Quality (NCQA)

Educate caregivers and patients on the risks of antibiotic resistance.

The Poster Board Pledge: Recent studies have shown that displaying poster-sized commitment letters in exam rooms to avoid inappropriate antibiotic prescribing was a simple, low-cost, and effective method for improvement.
? JAMA Internal Medicine

* The National Committee for Quality Assurance (NCQA) is the most widely recognized accreditation program in the U.S.

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

‡ QIPS is a reimbursement system developed by Keystone Health Plan East for participating Pennsylvania primary care physicians that offers incentives for high-quality, accessible, and cost-effective care.

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