ACHA Clinical Benchmarking Program

Acute Care Module

Acute Care Measure: Avoidance of Antibiotic Treatment for Adults Aged 18-64 with Acute Bronchitis

The information on this page is intended to help you complete the Acute Care Module of the Clinical Benchmarking Program. A worksheet is offered for each of the three measures in the Acute Care Module to help you organize your submission before entering it directly into the Clinical Benchmarking Program Data Input Tool. Once you have completed all three worksheets for this module, please use the link provided in your email invitation to submit the information compiled in the worksheet to ACHA. If you need help accessing the unique link for your institution, please contact ACHA Research Director Victor Leino.

Download Background, Instructions, and Worksheet [pdf]       Download Background, Instructions, and Worksheet [doc]


The American College of Chest Physicians defines acute bronchitis as "an acute respiratory infection with a normal chest radiograph that is manifested by cough with or without phlegm production that lasts for up to 3 weeks".1 These illnesses are most often caused by viruses, though even bacterial bronchitis cases are most often self-limited as well and there are no clear criteria for differentiating the two. A 2004 Cochrane review revealed that antibiotics offer a "modest beneficial effect" balanced by potential negative effects.2 Antibiotics are not routinely recommended for this self-limited condition.

The Healthcare Effectiveness Data and Information set (HEDIS) currently includes a measure, unchanged in 2013 from previous iterations, which measures the avoidance of antibiotic treatment in adults with acute bronchitis.


Each health center should review 25 random charts of eligible patients seen with an initial diagnosis of either "acute cough illness" or acute bronchitis over the past 12 months (not repeat visits for the same illness). (Suggested ICD-9 codes include: 490, 466, 786.2)

Patient Eligibility

  • Patients should not have HIV infection or asymptomatic HIV, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic lung disease, respiratory disease (ICD 500-508) or tuberculosis 12 months prior to the episode date.
  • The patient should not have been on antibiotics 30 days prior or currently with the episode date.
  • No competing diagnosis 30 days before through seven days after episode date (see table below).
  • There should be a low suspicion for pertussis: cough illness < 3 weeks duration, no symptoms or signs consistent with pertussis, and no local outbreaks.
  • Pulmonary exam should not be consistent with pneumonia.

Scoring — for each eligible chart (should be 25 total):

  1. Were antibiotics prescribed for "acute cough" or "acute bronchitis"?
    Yes       No

Compliance — number of charts with no antibiotics prescribed/number of eligible charts (which should be 25).

Competing Diagnoses

Intestinal infections




Bacterial infection unspecified


Lyme disease and other arthropod-borne diseases

H66.13 (.23)

Otitis media


Acute sinusitis

J01.00 (.10)

Acute pharyngitis

J02.0 (.9) J03.0

Acute tonsilitis


Chronic sinusitis


Infections of the pharynx, larynx, tonsils, adenoids

J39.1, J04.0 



Cellulitis, mastoiditis, other bone infections

H70.1, L03.39, M86.9 (.1, .2)

Acute lymphadenitis



L01.00 (.03)

Skin staph infections



J13, J18

Gonococcal infections and venereal diseases

A54.21, Z20.2





Inflammatory diseases (female reproductive organs)


Infections of the kidney


Cystitis or UTI

N30.0 (.1), N39.0  


1Braman, Sidney S. Chronic Cough Due to Acute Bronchitis: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2006, Jan; 129: 95s-103s.

2Smith et al. Antibiotics for acute bronchitis. The Cochrane Library published 18 October 2004 and reassessed 6 September 2010