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2013 New Jersey HMO Performance Report
Respiratory Conditions

How well does the HMO help members with respiratory conditions?

HMOs should work with doctors to provide important services that help improve the health of members with respiratory conditions. HMOs reported on the percentage of their relevant membership who received the following services:

  • Testing children with pharyngitis for strep
  • Treatment for children with upper respiratory infection (URI)
  • Avoidance of antibiotic treatment in adults with acute bronchitis
  • Use of spirometry testing in the assessment and diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

The following tables show how well each HMO did and how well HMOs in New Jersey performed on average.


HMO Strep testing for
children with pharyngitis %
Treatment for children with Upper Respiratory Infection % Avoidance of antibiotic treatment in adults w/acute bronchitis % Use of spirometry testing in diagnosis of
COPD %
Aetna - HMO/POS 79 84 18 45
AmeriHealth - HMO/POS 81 85 20 36
CIGNA - HMO/POS 83 86 18 48
Horizon - HMO 81 81 20 48
Oxford - HMO/POS 84 84 21 49
 
Testing children with pharyngitis for strep
Strep testing is recommended for detection of Pharyngitis. The percentage of children 2-18 years of age diagnosed with pharyngitis and dispensed an antibiotic who also received a strep test for the episode (a higher rate represents better performance):
  Avoidance of antibiotic treatment* for children with upper respiratory infection (URI)
An upper respiratory infection (URI) is one of the most common illnesses, leading to more doctor visits. The percentage of children 3 months to 18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic:
Testing children with pharyngitis for strep  
Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
     
Avoidance of antibiotic treatment* in adults with acute bronchitis
Use of antibiotics usually is not an appropriate treatment for acute bronchitis. The percentage of adults ages 18-64 years with a diagnosis of acute bronchitis who were not dispensed an antiobiotic prescription (a higher rate indicates lower antibiotic use, which is appropriate):
  Use of spirometry testing in the assessment and diagnosis of COPD
Spirometry testing measures air flow through the lungs and can confirm a COPD diagnosis. Members 40 years of age and older with a new diagnosis or newly active COPD who received appropriate spirometry testing to confirm the diagnosis:
Avoidance of antibiotic treatment in adults with acute bronchitis
 
Use of spirometry for testing for children with pharyngitis
*Inappropriate use of antibiotics has been shown to promote resistant bacteria that are more difficult to treat. The Centers for Disease Control and other organizations urge physicians to avoid prescribing antiobiotics when not medically indicated.
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