Best Practice:
Urgent Care PQRS
1
Appropriate Testing for Children
with Pharyngitis
Rationale: This measure assesses the proportion of
age‐appropriate children diagnosed with pharyngitis who
were prescribed an antibiotic at an outpatient visit and who
received a group A streptococcus (group A strep) test. This
test, which is widely available to practitioners, can result in
a reduction of two‐thirds of antibiotic consumption of
pharyngitis while maintaining significant benefits for
patients.
2
Appropriate Testing for Children
with Pharyngitis
Research overview: Percentage of children 2-18 years of
age who were diagnosed with pharyngitis, ordered an
antibiotic and received a Group A streptococcus test.
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Denominator: All patients who had an outpatient or ED visit with
diagnosis of Pharyngitis and antibiotic ordered on or up to three
days after the visit.
Numerator: Patients who met the denominator criteria and who had
a Group A Streptococcus test in the 7-day period from 3 days prior
through 3 days after the diagnosis of Pharyngitis.
Exclusions: Children who were taking antibiotics in the 30 days prior
to the diagnosis of Pharyngitis.
3
Appropriate Testing for Children
with Pharyngitis—Results
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42 patients who had an outpatient or ED visit with diagnosis of
Pharyngitis and antibiotic ordered on or up to three days after the
visit (denominator).
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Of these, 41 had private insurance
22 females, 20 males
34 white, 7 black or African American, 1 Hispanic or Latino
36 patients met the denominator criteria and had a Group A
Streptococcus test in the 7-day period from 3 days prior through 3
days after the diagnosis of Pharyngitis (numerator).
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–
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Of these, 35 had private health insurance
19 female, 17 male
29 white, 2 black or African American, 1 Hispanic or Latino
1 child was taking antibiotics in the 30 days prior to the diagnosis of
Pharyngitis (exclusion).
4
Preventive Care and Screening:
Influenza Immunization
Rationale: Annual influenza vaccination is the most
effective method for preventing influenza virus infection and
its complications. Influenza vaccine is recommended for all
persons aged ≥ 6 months who do not have
contraindications to vaccination.
5
Preventive Care and Screening:
Influenza Immunization
Research overview: Percentage of patients aged 6 months
and older seen for a visit between October 1 and March 31
who received an influenza immunization OR who reported
previous receipt of an influenza immunization.
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•
•
Denominator: All patients aged 6 months and older seen for a visit
between October 1 and March 31.
Numerator: Patients who received an influenza immunization or who
reported previous receipt of influenza immunization.
Exclusions: Active medication allergy before end of measurement
period, temporary or permanent deferral of immunization, vaccine
not available or other system reason.
6
Preventive Care and Screening:
Influenza Immunization—Results
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230 patients aged 6 months and older seen for a visit between
October 1 and March 31 (denominator).
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Of these 202 had private insurance, 13 were covered by Medicare
132 females, 100 males
180 white, 23 black or African American, 10 Hispanic or Latino
160 patients received an influenza immunization or reported
previous receipt of influenza immunization (numerator).
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Of these, 140 had private health insurance
94 females, 65 males
122 white, 19 black or African American, 3 Hispanic or Latino
One patient with Active Medication Allergy before end of
measurement period, Temporary or Permanent Deferral of
Immunization, Vaccine not available or other system reason.
7
Documentation of Current
Medications in the Medical Record
Rationale: capturing critical patient information—including
medical and medication histories, current medications the
patient is receiving and taking, and sources of
medications—is essential to the delivery of safe medical
care. However, interruptions in the continuity of care and
information gaps in patient health records are common and
significantly affect patient outcomes. Consequently, clinical
judgments may be based on incomplete, inaccurate, poorly
documented or unavailable information about the patient
and his or her medication.
8
Documentation of Current
Medications in the Medical Record
Research Overview: Percentage of visits for patients aged
18 years and older for which the eligible professional
attests to documenting a list of current medications using
all immediate resources available on the date of the
encounter.
•
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Denominator: All visits for patients 18 years and older.
Numerator: Eligible professional attests to documenting, updating or
reviewing a patient’s current medications using all immediate
resources available on the date of encounter.
9
Documentation of Current Meds in
the Medical Record—Results
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•
4,072 visits by patients 18 years and older (denominator).
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Of these 3,290 had private insurance, 179 were covered by Medicare
2,242 females, 1,599 males
2,679 white, 779 black or African American, 133 Hispanic or Latino
4,062 patient visits in which eligible professional attests to
documenting, updating or reviewing a patient’s current medications
using all immediate resources available on the date of encounter
(numerator).
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Of these, 3,282 had private health insurance
2,237 females, 1,596 males
2,671 white, 778 black or African American, 133 Hispanic or Latino
10
Preventive Care and Screening:
BMI and Follow-Up
Rationale: Of the Medicare population, 37 percent are
overweight, and 18 percent are obese. Between 1991 and
1998, the prevalence of obesity among persons age 60-69
increased by 45 percent (American Obesity Association).
According to a 1998 survey, only 52 percent of adults age
50 or older reported being asked during routine medical
check-ups about physical activity or exercise. The
likelihood of being asked about exercise during a routine
check-up declined with age (Center for the Advancement of
Health, 2004).
11
Preventive Care and Screening:
BMI and Follow-Up
Research Overview: Percentage of patients aged 18 years
and older with a documented BMI during the encounter or
during the previous six months, AND when the BMI is
outside of normal parameters, a follow-up plan is
documented during the encounter or during the previous
six months of the encounter for Age 18 to 64 years old and
BMI => 18.5 and < 25.
12
Preventive Care and Screening:
BMI and Follow-Up
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Denominator: All patients in the initial patient population and have 1
or more outpatient encounters.
Numerator: Patients with a documented BMI during the encounter or
during the previous six months, AND when the BMI is outside of
normal parameters, follow-up is documented during the encounter or
during the previous six months of the encounter with the BMI outside
of normal parameters.
Exclusions: Diagnosis of terminal illness or pregnancy; physical
exam not performed.
13
Preventive Care and Screening:
BMI and Follow-Up--Results
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3,543 patients in the initial patient population and have 1 or more
outpatient encounters (denominator).
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Of these 3,105 had private insurance, 70 were covered by Medicare
2,056 females, 1,486 males
2,486 white, 704 black or African American, 125 Hispanic or Latino
1,420 patients with a documented BMI during the encounter or
during the previous six months, AND when the BMI is outside of
normal parameters, follow-up is documented (numerator).
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Of these 1,262 had private health insurance, 16 were covered by Medicare
965 females, 455 males
1,109 white, 159 black or African American, 41 Hispanic or Latino
Zero patients with diagnosis of terminal illness or pregnancy;
physical exam not performed.
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