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HEDIS Measure Deep Dive: Appropriate Treatment for Upper Respiratory Infection

The Appropriate Treatment for Upper Respiratory Infection measure, or URI, is a metric derived from the percentage of members (three months and older) with a diagnosis of upper respiratory infection that did not result in an antibiotic event. Typically, antibiotics are not recommended for upper respiratory infection, as these are usually viral in nature. Research has shown that the use of antibiotics for diagnoses for which it is not appropriate or warranted, such as upper respiratory infection, is not only ineffective in reducing complications, but also increases medical costs by inducing side effects and resistance to antibiotics (Yoon et al., 2017 – view this .gov resource here). This measure is therefore inverted, meaning the less antibiotics providers prescribe in response to upper respiratory infections, the better.

To close the gap and thus improve HEDIS scores, this measure relies on provider prescribing practices to reflect an avoidance of antibiotic prescriptions in response to upper respiratory infection on or three days after the day of diagnosis.

Recommendations:

  • Providers are encouraged to educate members, parents, and caregivers on alternative remedies to antibiotics such as acetaminophen for fever, over the counter medicine for cough and inflammation, and rest and extra fluids for treatment.
  • Per the CDC, it is encouraged that providers promote appropriate antibiotic use to avoid antibiotic resistance. The CDC website has some very useful handouts for both patients and providers that talk about appropriate antibiotic use and includes resources such as specific antibiotic aware prescription pads for provider use.