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Developing a quality measure to assess use of antibiotic medications for respiratory conditions
Brandi L Melville1, Taylor Musser1, Ezra Fishman1
1National Committee for Quality Assurance, Washington, DC.
Objective:
Antibiotics are essential medications for treating life-threatening infections. However, incorrect prescribing can lead to adverse events and contribute to antibiotic resistance. We sought to develop a utilization quality measure that could be used by health insurance plans to track overall prescribing for respiratory conditions.
Design:
A consensus-based process that included evidence review, testing, and stakeholder input was used to develop a measure and assess its usefulness for the Healthcare Effectiveness Data and Information Set (HEDIS), a national quality measurement tool.
Methods:
Guidelines and literature were reviewed to establish the rationale for the measure. The measure was tested in claims data for commercial, Medicaid and Medicare Advantage enrollees to assess feasibility of collecting and reporting needed information. The measure was vetted with multistakeholder advisory panels and posted for public comment to solicit wide input on relevance and usability.
Results:
Respiratory conditions are frequent reasons for outpatient care in the data assessed. On average, across all lines of business, the measure revealed that approximately one-third of outpatient visits for respiratory conditions are followed by antibiotics. Stakeholders supported the measure as a tool for monitoring antibiotic prescribing across health plans alongside existing measures that assess inappropriate prescribing for specific conditions. The final measure assesses the number of antibiotic prescriptions dispensed across all outpatient respiratory-related encounters at a health-plan level.
Conclusions:
The measure on antibiotic prescribing for respiratory conditions was relevant, feasible, and useful. Stakeholders strongly supported the newly developed measure and recommended its integration into HEDIS.
Insights
A new quality measure helps health plans track antibiotic prescribing for respiratory conditions, finding about one-third of outpatient visits result in antibiotic prescriptions. This measure aims to combat antibiotic resistance and improve patient safety.
Area of Science:
- Health Services Research
- Quality Improvement
- Pharmacoeconomics
Background:
- Antibiotic misuse contributes to adverse events and antibiotic resistance.
- Effective tracking of antibiotic prescribing is crucial for healthcare quality.
- Respiratory conditions are common reasons for outpatient antibiotic use.
Purpose of the Study:
- To develop a utilization quality measure for health insurance plans.
- To track overall antibiotic prescribing for respiratory conditions.
- To assess the measure's usefulness for the Healthcare Effectiveness Data and Information Set (HEDIS).
Main Methods:
- A consensus-based process involving evidence review, testing, and stakeholder input.
- Review of guidelines and literature to establish measure rationale.
- Testing in claims data (commercial, Medicaid, Medicare Advantage) for feasibility.
- Vetting with multistakeholder advisory panels and public comment.
Main Results:
- Respiratory conditions are frequent reasons for outpatient care.
- Approximately one-third of outpatient visits for respiratory conditions were followed by antibiotics.
- The measure assesses antibiotic prescriptions dispensed across all outpatient respiratory encounters at a health plan level.
Conclusions:
- The developed measure for antibiotic prescribing in respiratory conditions is relevant, feasible, and useful.
- Stakeholders strongly supported the measure.
- Integration into HEDIS was recommended to monitor antibiotic prescribing across health plans.
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