Measuring the Quality of Care for Group A Streptococcal Pharyngitis in 5 US Health Plans

Published in: Archives of Pediatrics and Adolescent Medicine, v. 159, no. 5, May 2005, p. 491-497

Posted on on January 01, 2005

by Rita Mangione-Smith, Marc N. Elliott, Lok Wong, Laurie L. McDonald, Joachim Roski

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: There is a high degree of professional consensus that children diagnosed with pharyngitis should only receive antibiotics if they have a positive test for group A streptococcus (GAS). OBJECTIVES: To develop and test the validity of a quality of care performance measure that examines GAS testing rates in children diagnosed with pharyngitis and prescribed an antibiotic. DESIGN: The measure developed examines the annual rate of GAS testing in children aged 2 to 18 years with an episode of pharyngitis who were prescribed antibiotics. The measure was tested for feasibility of implementation and validity in 5 health plans in the United States. Health plan administrative data were used to identify episodes of pharyngitis using International Classification of Diseases, Ninth Revision (ICD-9) codes 462, 463, and 034.0. Pharmacy data (National Drug Codes) were used to determine if antibiotics were prescribed for the pharyngitis episode. Laboratory claims data (Current Procedural Terminology codes) were used to determine whether a GAS test was performed. Rates of GAS testing in children with pharyngitis who received antibiotics were calculated for each health plan. Medical record abstractions were performed on a random sample (n = 465) of cases to assess percent agreement with laboratory claims data for GAS testing. Sensitivity of the administrative data for accurately identifying when GAS tests were performed was also assessed. RESULTS: Of the 120 158 children aged 2 to 18 years who had at least 1 episode of pharyngitis during the measurement year, 51 172 (43%) received antibiotics. Group A streptococcal testing rates for patients who were prescribed antibiotics varied widely among the participating health plans (59%-83% of cases; P<.05). Percent agreement between administrative and medical records data for GAS tests was 86%. The sensitivity of the administrative data for accurately identifying when GAS tests were performed was 85%. CONCLUSIONS: This quality measure is feasible to implement at the health plan level and validly assesses GAS testing rates using administrative data. The participating health plans are not performing GAS tests as indicated by current expert practice guidelines in a substantial proportion of cases. Improvements in adhering to these guidelines are warranted given the current levels of antibiotic overuse and antibiotic resistance nationally.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.