This measure assesses the percentage of episodes for members 3 months of age and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event.
Why It Matters?
Approximately 269 million antibiotic prescriptions are dispensed annually in the United States.1 While these medications are life-saving interventions for conditions such as sepsis, nearly 30% of antibiotics prescribed in outpatient settings are potentially inappropriate.2,3 Antibiotics prescribed for respiratory conditions in outpatient settings are a large driver of antibiotic overuse and demonstrate a higher proportion of events resulting in unnecessary use.
Misuse of antibiotics can allow antibiotic-resistant bacteria to survive and multiply. Overuse drives the development and spread of resistance. A report by the Centers for Disease Control and Prevention (CDC) estimates that more than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result.4 Antibiotics prescribed for acute respiratory conditions accounted for 55% (22.6 million) of all antibiotic prescriptions, at a cost of approximately $726M, with upper respiratory infections (not otherwise specified), pharyngitis and bronchitis having the greatest amount of excess use.5 For influenza alone, the estimated annual cost of inappropriate antibiotic prescribing in the United States is approximately $211M.6
Several campaigns and resources are available to help clinicians and health plans address inappropriate antibiotic prescribing. These campaigns include CDC’s Be Antibiotics Aware and the American Board of Internal Medicine Choosing Wisely campaign. The CDC has also partnered with payers, physicians and other health care stakeholders to prioritize six high-burden health conditions, including improving antibiotic use in its CDC 6|18 Initiative: Improve Antibiotic Use campaign. This initiative highlights evidence-based interventions for improving antibiotic prescribing and supports health plans by incentivizing providers to follow CDC’s Core Elements of Outpatient Antibiotic Stewardship:7 1.) commitment; 2.) action for policy and practice; 3.) tracking and reporting; 4.) education and expertise.
Historical Results – National Averages
Antibiotic Utilization for Respiratory Conditions (Total)
| Measurement Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2023 | 28.3 | 28.8 | 26.1 | 18.2 | 20.9 |
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
- CDC. 2017. Antibiotic Use in Outpatient Settings, 2017. Retrieved from https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html#anchor_1502199164
- CDC. 2018. Antibiotic Use in the United States, 2018 Update: Progress and Opportunities. Atlanta, GA: US Department of Health and Human Services, CDC.
- Fleming-Dutra, K.E., A.L. Hersh, D.J. Shapiro, et al. 2016. “Prevalence of Inappropriate Antibiotic Prescriptions among US Ambulatory Care Visits, 2010–2011.” JAMA 315(17), 1864–73. doi:10.1001/jama.2016.4151
- CDC. 2019c. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.
- Gonzales, R., D.C. Malone, J.H. Maselli, & M.A. Sande. 2001. “Excessive Antibiotic Use for Acute Respiratory Infections in the United States.” Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America 33(6), 757–62. https://doi.org/10.1086/322627
- Misurski, D.A., D.A. Lipson, & A.K. Changolkar. 2011. “Inappropriate Antibiotic Prescribing in Managed Care Subjects with Influenza.” The American Journal of Managed Care 17(9), 601–8.
- CDC. 2019d. Improving outpatient antibiotic use through audit and feedback. Retrieved from https://www.cdc.gov/antibiotic-use/community/pdfs/Audit-feedback-outpatient-antibiotic-use-508.pdf
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