Journal Article’s Lessons
Go Beyond Its Topic

January 26, 2023 · Andy Reynolds

The recent publication of a journal article about the HEDIS measure Antibiotic Utilization for Respiratory Conditions (AXR) prompted us to share some things about that article and about the measure.

Measure Development Overview

There’s a lot to learn from “Developing a quality measure to assess use of antibiotic medications for respiratory conditions,” published in the January edition of Antimicrobial Stewardship & Healthcare Epidemiology.

The article helps readers understand how NCQA develops quality measures, including:

• Conceptualization. Advisors from health plans, public health and scientific organizations give us input on what to look for in a measure—and how health plans could feasibly measure what we are looking for.
• Specification. We draft measures based on advisors’ input.
• Field-testing. To understand how the measure might work in the real world, we test it using actual data.
• Public comment. We put our draft measure online for a month for anyone to critique and make suggestions.

(An aside about public comment: The next HEDIS public comment will run from mid-February to mid-March. Check our blog in February or subscribe to Quality Matters for details.)

Think antibiotic resistance doesn’t affect you or your organization? Keep reading.

Fighting a Pernicious Problem

Antibiotic resistance caused by inappropriate use of antibiotics is a serious problem we discuss often.

People who care about quality and public health need to remember that antibiotic resistance kills enough Americans to fill a stadium and adds $20 billion to health care costs—every year.

NCQA’s recent work to encourage responsible use of antibiotics was funded by the Pew Antibiotics Resistance Project to:

• Offer free webinars that help health plans improve how they manage antibiotics.
• Highlight plans whose antibiotic stewardship is sound and effective.

We built the AXR measure to work in combination with three other HEDIS measures of antibiotic stewardship:

• Appropriate Testing for Pharyngitis.
• Appropriate Treatment for Upper Respiratory Infection.
• Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis.

The key contribution of AXR is that it’s a utilization measure.  

That makes it different from the other measures, where higher or lower rates describe better or poor performance.

AXR gives plans a different lens to study what’s really going on with their antibiotics utilization. Plans use it to compare prescribing for conditions where using antibiotics is advisable (for strep throat, for example) versus conditions where it is not (for the common cold).

That’s an important capability. We’ll go into more detail about it in future posts.

For now, we’ll end by celebrating the staff who built and wrote about AXR.

Long-Term Teamwork

These NCQA staff joined Brandi Melville to co-author the journal article:

• Sepheen C. Byron, Assistant Vice President, Performance Measurement.
• Ezra Fishman, Lead Data Scientist.
• Taylor Musser, Director of Measure Validation.
• Danielle Rainis, Senior Health Care Analyst.

Just as fighting antibiotic resistance takes vigilance, finishing the study and getting it published took teamwork and patience.

Given the topic, that persistence is fitting. If responsible use of antibiotics requires a steady commitment, why shouldn’t writing and publishing about it?

(A final aside: We’re eager to build on the work of Sepheen, Ezra, Taylor and Danielle. That means growing our team so we can keep improving health and health care for all Americans.

If that mission appeals to you, we’re hiring!

Check out our list of open positions.)