Appropriate Testing for Pharyngitis

Identifying Attributes

Care Settings
Primary Care
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Traditional Merit-based Incentive Payment System (MIPS)
Type of Quality Indicator
Process
IOM Quality Dimension
Effectiveness
Domain
Medications and Medication Management

Defining Attributes

Definition

The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order on or three days after the episode date and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date

Numerator

A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date.

Denominator

Outpatient, telephone, online assessment (i.e., e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis from January 1 to December 28 of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older

Exclusions

Exclude pharyngitis episodes when the patient had hospice care for any part of the measurement period; when the patient had a comorbid condition during the 12 months prior to or on the episode date; where the patient is taking antibiotics in the 30 days prior to the episode date; where the patient had a competing diagnosis on or three days after the episode date

Use of Risk Adjustment
No
Risk Adjustments

None

Stratifications

By age group (3 months-17 years, 18-64 years, 65 years and older)

Collection and Reporting Attributes

Type of Data Collection
Administrative data
Data Collection Methods

MIPS Clinical Quality Measures (CQMS)

Frequency of Data Collection
Annually
Frequency of Data Collection in Days
365
Reporting Methods

Traditional MIPS

Reporting Frequency
Annually
Reporting Frequency in Days
365
Indicator Has Recommended Targets
No

Source and Reference Attributes

Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
Can the Quality Indicator be Readily Implemented at a Population Level in Australia Given its Current Data Landscape?
Implementation of this quality indicator was not assessed.
Identified by PHARMA-Care Project
No
Upload Date
31 March 2026