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2016 New Jersey HMO and PPO Performance Report
Respiratory Conditions

How well does the HMO or PPO help members with respiratory conditions?

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

  • 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 spirometry testing in the assessment and diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

The following table shows how well each HMO and PPO performed. The bar graphs following show the HMOs and PPOs compared to the New Jersey average.

 
 
Testing children with pharyngitis for strep

Strep testing is recommended for the detection of pharyngitis. The bar graphs show the percentage of children aged 2-18 who received a strep test to diagnose pharyngitis and then were given an antibiotic.

A higher percentage rate is better for this health measure. A higher percentage shows that more children and adolescents received an appropriate strep test before getting an antiobiotic prescription medication to treat pharyngitis.

HMO   PPO
HMO Testing children with pharyngitis for strep   PPO Testing children with pharyngitis for strep
     
Avoidance of antibiotic treatment* for children with upper respiratory infection

An upper respiratory infection (URI) is one of the most common illnesses, resulting in more doctor visits. The bar graphs show the percentage of children 3 months to 18 years of age with a diagnosis of upper respiratory infection (URI) and who were not dispensed an antibiotic.

A higher percentage rate is better for this health measure. It means more infants, children and adolescents were not prescribed possibly unnecessary antibiotic medication.

HMO   PPO
HMO Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
 
PPO Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
*Inappropriate use of antibiotics has been shown to promote resistant bacteria that are more difficult to treat. The federal Centers for Disease Control and Prevention (CDC) and other organizations urge physicians to avoid prescribing antiobiotics when not medically indicated. Since the cause of most URI's is viral, antibiotics are unnecessary.
     
Avoidance of antibiotic treatment* for adults with acute bronchitis

Use of antibiotics usually is not an appropriate treatment for acute bronchitis. The bar graphs show the percentage of adults ages 18-64 years with a diagnosis of acute bronchitis and who were not dispensed an antiobiotic prescription.

A higher percentage rate is better for this health measure. A higher percentage rate indicates that more adults with acute bronchitis were not prescribed possibly unnecessary antiobiotic medication as part of their treatment.

HMO   PPO
HMO Avoidance of antibiotic treatment in adults with acute bronchitis
 
PPO Avoidance of antibiotic treatment in adults with acute bronchitis
*Inappropriate use of antibiotics has been shown to promote resistant bacteria that are more difficult to treat. The federal Centers for Disease Control and Prevention (CDC) and other organizations urge physicians to avoid prescribing antiobiotics when not medically indicated.
     
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. The bar graphs show the percentage of members, 40 years of age and older, with a new diagnosis or newly active COPD who received appropriate spirometry testing to confirm the diagnosis.

A higher percentage rate is better for this measure. It means more adults who are 40 and above received the best diagnostic lung function test for COPD.
HMO   PPO
HMO Use of spirometry for testing for children with pharyngitis
 
PPO Use of spirometry for testing for children with pharyngitis
 
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