Melville Brandi L, Musser Taylor, Fishman Ezra, Rainis Danielle, Byron Sepheen C
National Committee for Quality Assurance, Washington, DC.
Antimicrob Steward Healthc Epidemiol. 2023 Jan 17;3(1):e13. doi: 10.1017/ash.2022.328. eCollection 2023.
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.
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.
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.
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.
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.
抗生素是治疗危及生命感染的重要药物。然而，不正确的处方可能导致不良事件并助长抗生素耐药性。我们试图制定一种利用质量指标，可供健康保险计划用来跟踪呼吸系统疾病的总体处方情况。
采用了一个基于共识的过程，包括证据审查、测试和利益相关者的意见，以制定一项指标并评估其对全国质量测量工具医疗保健有效性数据和信息集（HEDIS）的有用性。
审查指南和文献以确立该指标的基本原理。在商业保险、医疗补助和医疗保险优势计划参保者的理赔数据中对该指标进行测试，以评估收集和报告所需信息的可行性。该指标经多利益相关者咨询小组审核，并发布以供公众评论，以就相关性和可用性征求广泛意见。
在所评估的数据中，呼吸系统疾病是门诊治疗的常见原因。在所有业务范围内，该指标平均显示，约三分之一的呼吸系统疾病门诊就诊后会开具抗生素处方。利益相关者支持将该指标作为一种工具，与评估特定疾病不适当处方的现有指标一起，用于监测各健康计划中的抗生素处方情况。最终指标在健康计划层面评估所有门诊呼吸相关诊疗中开具的抗生素处方数量。
呼吸系统疾病抗生素处方指标具有相关性、可行性和实用性。利益相关者强烈支持新制定的指标，并建议将其纳入HEDIS。
