Assesses the percentage of episodes for members 3 years of age and older with a diagnosis of pharyngitis, dispensed an antibiotic and received a group A streptococcus test for the episode. A higher rate indicates completion of the appropriate testing required to merit antibiotic treatment for pharyngitis.
Why It Matters
Pharyngitis, or sore throat, is a leading cause of outpatient care and can be caused by a viral or bacterial infection. 1 Viral pharyngitis does not require antibiotic treatment, but antibiotics continue to be inappropriately prescribed. Proper testing and treatment of pharyngitis prevents the spread of sickness, while reducing unnecessary use of antibiotics. 2 The misuse of antibiotics can have adverse clinical outcomes such as Clostridioides difficile infections and has public health implications including encouragement of antibiotic resistance (when antibiotics can no longer cure bacterial infections). Antibiotic resistance is a major health concern in the United States, with 2.8 million antibiotic-resistant infections and 35,000 deaths occurring annually. 3
Results – National Averages
Appropriate Testing Rate
| Measure Year | Commerical HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 66.7 | 69.3 | 71 | 39.5 | 44.5 |
| 2021 | 64.3 | 66.3 | 67.6 | ||
| 2020 | 71.8 | 73.0 | 74.3 | ||
| 2019 | 74.9 | 75.9 | 75.3 | ||
| 2018 | 87.3 | 86.4 | 79.6 | 56.3 | 60.1 |
| 2017 | 86.8 | 85.7 | 78.3 | 55.2 | 59.0 |
| 2016 | 80.7 | 78.4 | 66.5 | 54.4 | 59.4 |
| 2015 | 82.8 | 81.1 | 71.1 | 55.8 | 57.6 |
| 2014 | 82.4 | 80.4 | 69.5 | 54.7 | 58.4 |
| 2013 | 80.7 | 78.4 | 66.5 | 53.3 | 56.8 |
| 2012 | 80.2 | 78.9 | 68.0 | 56.9 | 61.0 |
| 2011 | 80.2 | 79.3 | 66.7 | 53.3 | 58.4 |
| 2010 | 77.6 | 76.6 | 64.9 | 51.9 | 55.7 |
| 2009 | 77.4 | 75.5 | 62.3 | 50.6 | 51.0 |
| 2008 | 75.6 | 74.1 | 61.4 | 49.3 | 48.9 |
| 2007 | 74.7 | 73.5 | 58.7 | 48.7 | 48.7 |
| 2006 | 72.7 | 69.4 | 56.0 | 45.1 | 40.9 |
| 2005 | 69.7 | 64.5 | 52.0 | 41.1 | 31.1 |
| 2004 | 72.6 | - | 54.4 | 42.4 | - |
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- K. Simon. 2014. “Pediatric Pharyngitis.” http://emedicine.medscape.com/article/967384-overview
- Centers for Disease Control and Prevention. 2013. “Is It Strep Throat?” http://www.cdc.gov/Features/strepthroat/
- Centers for Disease Prevention and Control. 2019. “Antibiotic Resistance Threats in the United States.” https://www.cdc.gov/drugresistance/biggest-threats.html