HEDIS® Measure Focus: Treatment for Children with Upper Respiratory Infections (URIs)

HEDIS® Measure Focus: Treatment for Children with Upper Respiratory Infections (URIs)


We use Healthcare Effectiveness Data and Information Set (HEDIS) measures to identify potential gaps in care. We also use these measures to improve the overall health outcomes for your patients. We aim to give you measure-specific information to support your efforts in providing quality care to our members and avoid potential gaps in care.

Measure: Upper Respiratory Infection (URI)

Viruses that don’t require antibiotic treatment cause most URIs. Often, providers prescribe antibiotics unnecessarily. This can cause antibiotic resistance. This measure focuses on not treating children ages 3 months to 18 years with a URI with antibiotics.

This measure assesses the percentage who:

  • Were diagnosed with a URI.
  • Were not diagnosed with a competing or similar diagnosis.
  • Did not receive an antibiotic on or three days after the diagnosis date.

What You Can Do

  • Avoid prescribing antibiotics for children with a URI diagnosis (or a competing diagnosis) on the day of diagnosis or the following three days.
  • If you are treating a patient for another condition or illness, document the other diagnosis code on the claim.
  • Use the Centers for Disease Control and Prevention (CDC) over-the-counter prescription pad available at http://www.cdc.gov/getsmart/campaign-materials/print-materials/ViralRxPad-bw.pdf. (This link leads to a third party site. That company is solely responsible for the contents and privacy policies on its site.) The CDC is an independent company that offers health education information on behalf of BlueCross BlueShield of South Carolina and BlueChoice HealthPlan.

We appreciate your continued commitment to identify potential gaps in care and improve the overall health outcomes for your BlueCross and BlueChoice® patients.

Please contact Provider Education for information about this bulletin at provider.education@bcbssc.com or by calling 803-264-4730.

BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association