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## Complete Summary

#### TITLE

Pediatric acute gastroenteritis: percentage of patients aged 1 month to
5 years of age with a diagnosis of acute gastroenteritis for whom an
appropriate oral rehydration solution was recommended.

#### SOURCE(S)

American Academy of Pediatrics, American Academy of Family Physicians,
Physician Consortium for Performance Improvement®. Pediatric acute
gastroenteritis physician performance measurement set. Chicago (IL):
American Medical Association (AMA); 2005 May. 7 p. \[1 reference\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of pediatric acute
gastroenteritis patients for whom an appropriate oral rehydration
solution was recommended.

#### RATIONALE

According to the American Academy of Pediatrics (AAP) and the U.S.
Centers for Disease Control and Prevention (CDC), oral rehydration
therapy (ORT) is the preferred treatment of fluid and electrolyte losses
caused by diarrhea in children with mild to moderate dehydration.

A variety of oral hydration solutions (ORS) are available in the United
States. Those most readily available commercially and used most commonly
have sodium concentrations ranging from 45 to 50 mmol/L.

Oral rehydration solutions should be used for rehydration. Oral
rehydration therapy should be performed rapidly (within 3-4 hours) for
rehydration in patients with mild to moderate dehydration. Patients
should receive 50-100 ml of oral rehydration solution (ORS)/kg of body
weight during 2-4 hours to replace the estimated fluid deficit, with
additional ORS administered to replace ongoing losses.

ORS are the preferred solution for ORT. Other fluids, such as fruit
juices, do not contain the necessary electrolytes that need to be
replaced when a child is dehydrated due to vomiting and/or diarrhea.
Additionally, due to the high sugar content and low sodium content of
fruit juice, the administration of fruit juice to children who are
diagnosed with acute gastroenteritis can make diarrhea worse and result
in hyponatremia, resulting in a higher level of dehydration and severity
of condition due to fluid loss and electrolyte imbalance.

#### PRIMARY CLINICAL COMPONENT

Pediatric acute gastroenteritis; oral rehydration therapy; oral
rehydration solution (Pedialyte®, Enfalyte®, Rehydralyte®, CeraLyte®, or
WHO Solution)

#### DENOMINATOR DESCRIPTION

All patients aged 1 month to 5 years of age with the diagnosis of acute
gastroenteritis (see the related \"Denominator Inclusions/Exclusions\"
field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients for whom appropriate oral rehydration\* solution was
recommended

\*Appropriate oral rehydration solution includes, Pedialyte®, Enfalyte®,
Rehydralyte®, CeraLyte®, or WHO Solution.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Managing acute gastroenteritis among children: oral rehydration,
    maintenance, and nutritional
    therapy.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4362)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Practice parameter: the management of acute gastroenteritis in young
children. American Academy of Pediatrics, Provisional Committee on
Quality Improvement, Subcommittee on Acute Gastroenteritis.
Pediatrics1996 Mar;97(3):424-35.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8604285)

Snyder JD. Use and misuse of oral therapy for diarrhea: comparison of US
practices with American Academy of Pediatrics recommendations.
Pediatrics1991 Jan;87(1):28-33.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1984614)

### State of Use of the Measure

#### STATE OF USE

Pilot testing

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Emergency Medical Services\
Hospitals\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age 1 month to 5 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients aged 1 month to 5 years of age with the diagnosis of acute
gastroenteritis

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 1 month to 5 years of age with the diagnosis of acute
gastroenteritis

**Exclusions**\
Documentation of medical reason(s) for not recommending appropriate oral
rehydration solution (patient was not dehydrated; patient was admitted
to the hospital)

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients for whom appropriate oral rehydration\* solution was
recommended

\*Appropriate oral rehydration solution includes, Pedialyte®, Enfalyte®,
Rehydralyte®, CeraLyte®, or WHO Solution.

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Acute gastroenteritis: recommendation of appropriate oral rehydration
solution.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1835&doc=178)

#### MEASURE SET NAME

[Pediatric Acute Gastroenteritis Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1835&doc=9240)

#### SUBMITTER

American Medical Association on behalf of the American Academy of
Pediatrics, the American Academy of Family Physicians, and the Physician
Consortium for Performance Improvement®

#### DEVELOPER

American Academy of Family Physicians\
American Academy of Pediatrics\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

James Berman, MD, FAAP (*Co-Chair*); Michael Goldberg, MD (*Co-Chair*);
Bruce Bagley, MD; David Classen, MD; Todd Davis, MD, FAAP; Debra Esser,
MD; David G. Jaimovich, MD; Eric Handler, MD, MPH; Mark Hostetler, MD,
MPH; Lowell Keppel, MD, CPE, FACPE, FAAFP; Samuel Kocoshis, MD; Marlene
Miller, MD, MSc, FAAP; Heather Palmer, MD, BCh, SM, FAAP; Sam J.W.
Romeo, MD, MBA; Cheri Throop; Robert Walker, MD, FAAP; Josie Williams,
MD, MMM

Raquel Gabriel-Bennewitz (JCAHO), Liaison; Phill Renner (NCQA), Liaison

Junelle Speller, MPH, American Academy of Pediatrics

Janet Leiker, American Academy of Family Physicians

Erin O. Kaleba, MPH, American Medical Association; Karen Kmetik, PhD,
American Medical Association

Rebecca Kresowik, Consultant; Timothy Kresowik, MD, Consultant

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2005 May

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Academy of Pediatrics, American Academy of Family Physicians,
Physician Consortium for Performance Improvement®. Pediatric acute
gastroenteritis physician performance measurement set. Chicago (IL):
American Medical Association (AMA); 2005 May. 7 p. \[1 reference\]

#### MEASURE AVAILABILITY

The individual measure, \"Acute Gastroenteritis: Recommendation of
Appropriate Oral Rehydration Solution,\" is published in the \"Clinical
Performance Measures: Pediatric Acute Gastroenteritis.\" This document
and technical specifications are available in Portable Document Format
(PDF) from the American Medical Association (AMA)-convened Physician
Consortium for Performance Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on December 6, 2006.
The information was verified by the measure developer on October 23,
2006.

#### COPYRIGHT STATEMENT

Physician Performance Measures (Measures) and related data
specifications, developed by the Physician Consortium for Performance
Improvement® (the Consortium), are intended to facilitate quality
improvement activities by physicians.

These Measures are intended to assist physicians in enhancing quality of
care. Measures are designed for use by any physician who manages the
care of a patient for a specific condition or for prevention. These
performance Measures are not clinical guidelines and do not establish a
standard of medical care. The Consortium has not tested its Measures for
all potential applications. The Consortium encourages the testing and
evaluation of its Measures.

Measures are subject to review and may be revised or rescinded at any
time by the Consortium. The Measures may not be altered without the
prior written approval of the Consortium. Measures developed by the
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without modification, for noncommercial purposes, e.g., use by health
care providers in connection with their practices. Commercial use is
defined as the sale, license, or distribution of the Measures for
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Commercial uses of the Measures require a license agreement between the
user and American Medical Association, on behalf of the Consortium.
Neither the Consortium nor its members shall be responsible for any use
of these Measures.

THE MEASURES ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.

© 2005 American Medical Association. All Rights Reserved.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008