Best Practice: Urgent Care PQRS

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.

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. 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.

Appropriate Testing for Children with Pharyngitis—Results 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). 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). 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).

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.

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. 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.

Preventive Care and Screening: Influenza Immunization—Results 230 patients aged 6 months and older seen for a visit between October 1 and March 31 (denominator). 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). 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.

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.

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. 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.

Documentation of Current Meds in the Medical Record—Results 4,072 visits by patients 18 years and older (denominator). 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). 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

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).

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.

Preventive Care and Screening: BMI and Follow-Up 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.

Preventive Care and Screening: BMI and Follow-Up--Results 3,543 patients in the initial patient population and have 1 or more outpatient encounters (denominator). 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). 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.