Assesses the percentage of episodes for members 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event. A higher rate indicates appropriate treatment for URI (i.e., the percentage of episodes that were not prescribed an antibiotic).
Why It Matters
Most URIs, also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often antibiotics are prescribed inappropriately. 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. 1
Recent efforts to use antibiotics judiciously has resulted in fewer inappropriate antibiotics prescribed. However, antibiotic remains a problem.1 Increased education and awareness of appropriate treatment for URIs can reduce the danger of antibiotic-resistant bacteria.
Results – National Averages
Appropriate Treatment Rate
| Measure Year | Commerical HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 84.5 | 84.8 | 89.9 | 66.4 | 63.2 |
| 2021 | 86.7 | 87.3 | 89.6 | ||
| 2020 | 80.8 | 81.3 | 88.1 | ||
| 2019 | 78.6 | 78.7 | 87.0 | ||
| 2018 | 90.8 | 89.4 | 90.5 | 56.3 | 60.1 |
| 2017 | 88.8 | 87.8 | 89.1 | 55.2 | 59.0 |
| 2016 | 88.4 | 87.0 | 88.6 | 54.4 | 59.4 |
| 2015 | 88.3 | 86.7 | 87.8 | 55.8 | 57.6 |
| 2014 | - | 85.3 | 87.0 | 54.7 | 58.4 |
| 2013 | 85.2 | 83.2 | 85.2 | 53.3 | 56.8 |
| 2012 | 84.0 | 82.3 | 85.1 | 56.9 | 61.0 |
| 2011 | 83.9 | 82.0 | 85.3 | 53.3 | 58.4 |
| 2010 | 85.1 | 83.7 | 87.2 | 51.9 | 55.7 |
| 2009 | 84.1 | 82.5 | 86.0 | 50.6 | 51.0 |
| 2008 | 83.9 | 83.3 | 85.5 | 49.3 | 48.9 |
| 2007 | 83.5 | 83.0 | 84.1 | 48.7 | 48.7 |
| 2006 | 82.8 | 82.1 | 83.4 | 45.1 | 40.9 |
| 2005 | 82.9 | 81.9 | 82.4 | 41.1 | 31.1 |
| 2004 | 82.7 | - | 79.9 | 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
- Centers for Disease Prevention and Control. 2019. “Antibiotic Resistance Threats in the United States.” https://www.cdc.gov/drugresistance/biggest-threats.html