New NCQA Research Shows Variation in Antibiotic Prescribing

August 20, 2024 · Becky Kolinski

Antibiotic resistance is an ongoing global challenge, and its incidence is increasing in the U.S. Inappropriate prescribing—for example, for viral illnesses such as bronchitis—is a major contributor to antibiotic resistance. Tracking and monitoring antibiotic use for respiratory conditions can help ensure antibiotics are being prescribed correctly.

NCQA’s recent report, Analyzing Regional and Product Line Variations Across HEDIS^® Antibiotic Use Measures, is a resource for health care organizations seeking to improve antibiotic prescribing practices.

HEDIS Measures for Antibiotic Prescribing

Four HEDIS (Healthcare Effectiveness Data and Information Set) measures provide insight into antibiotic prescribing patterns.

• Antibiotic Utilization for Respiratory Conditions (AXR): The percentage of episodes for members 3 months and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event.
• Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): The percentage of episodes for members 3 months and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.
• Appropriate Treatment for Upper Respiratory Infection (URI): The percentage of episodes for members 3 months and older with a diagnosis of upper respiratory infection that did not result in an antibiotic dispensing event.
• Appropriate Testing for Pharyngitis (CWP): The percentage of episodes for members 3 years and older where the member was diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.

NCQA used current literature and data from all four HEDIS measures to develop the report. Health plans from 39 states and the District of Columbia were included in the analysis. NCQA used U.S. Census regions to determine plans’ geographic location, and looked at results for commercial, Medicare and Medicaid products.

Key Findings Related to Antibiotic Prescribing

NCQA’s analysis of HEDIS MY 2022 data provides insights into current antibiotic prescribing behavior:

• When comparing all four antibiotic measures by product line, Medicare plans generally performed lower than commercial or Medicaid plans. One reason may be the recent (MY 2019) addition of the Medicare product line to the HEDIS antibiotics measures.
• The South had lower performance for the AAB and URI measures for the Medicare population than other regions.
• There is wide variation in performance across regions for the AAB and CWP measures; the highest variations are in the East and West.
• Prescribing attitudes for acute bronchitis may be different from those for upper respiratory infections or pharyngitis.

There is a distinct lack of recent published literature on antibiotic prescribing. More research is needed to evaluate the effects of inappropriate antibiotic prescribing trends nationwide, and why it occurs at such high rates. Understanding variations in performance across HEDIS measures can help to identify areas for improvement.

How Health Plans Can Impact Antibiotic Prescribing

The report can help health plans optimize antibiotic use, reduce the spread of antibiotic resistance and improve patient outcomes. Organizations should practice responsible antibiotic stewardship to prevent the effects of antibiotic resistance and protect vulnerable populations:

• Track performance on HEDIS measures of antibiotic use to identify trends for specific providers or patient populations.
• Educate members and providers about antibiotic resistance and guidelines for appropriate use.
• Leverage resources from the CDC and PEW’s Antibiotic Resistance Project.

NCQA’s antibiotics website includes a list of high-performing health plans that meet HEDIS criteria of smart prescribing and overuse prevention. View a list of health plans that are responsible stewards of antibiotics.

What’s Next?

NCQA is eager to deepen our understanding of how a patient’s race and ethnicity may affect antibiotic prescribing.

• We’ll consider whether HEDIS measures for antibiotic prescribing can be stratified by race and ethnicity, and we’ll set a timeline for implementation.
• We’ll evaluate the potential impact of the Office of Management and Budget’s plans to revise federal statistical standards for collecting and reporting race and ethnicity data as we consider.

View the full report here.

Support for this project was provided by The Pew Charitable Trusts. The views expressed herein are those of the author(s), and do not necessarily reflect the views of The Pew Charitable Trusts.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.