National Quality Forum #: 0405
Description: Percentage of patients aged 6 weeks or older with a diagnosis of HIV/AIDS, who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis1
*Use the numerator and denominator that reflect patient population
Numerator:
Numerator 1: Patients who were prescribed PCP prophylaxis within 3 months of CD4 count below 200 cells/mm3
Numerator 2: Patients who were prescribed PCP prophylaxis within 3 months of CD4 count below 500 cells/mm3 or a CD4 percentage below 15%
Numerator 3: Patients who were prescribed PCP prophylaxis at the time of HIV diagnosis
*Aggregate Numerator = The sum of the three numerators
Denominator:
Denominator 1: All patients aged 6 years and older with a diagnosis of HIV/AIDS and a CD4 count below 200 cells/mm3, who had at least two visits during the measurement year, with at least 90 days in between each visit;
Denominator 2: All patients aged 1 through 5 years of age with a diagnosis of HIV/AIDS and a CD4 count below 500 cells/mm3 or a CD4 percentage below 15%, who had at least two visits during the measurement year, with at least 90 days in between each visit;
Denominator 3: All patients aged 6 weeks through 12 months with a diagnosis of HIV, who had at least two visits during the measurement year, with at least 90 days in between each visit
*Total Denominator = The sum of the three denominators
Patient Exclusions:
Denominator 1 exclusion: Patient did not receive PCP prophylaxis because there was a CD4 count above 200 cells/mm3 during the three months after a CD4 count below 200 cells/mm3
Denominator 2 exclusion: Patient did not receive PCP prophylaxis because there was a CD4 count above 500 cells/mm3 or CD4 percentage above 15% during the three months after a CD4 count below 500 cells/mm3 or CD4 percentage below 15%
Data elements:
Numerator/denominator 1:
- Is the patient 6 years or older and have a diagnosis of HIV? (Y/N)
- If yes, did the patient have at least two medical visits in the measurement year with at least 90 days between visits? (Y/N)
- If yes, did the patient have a CD4 count <200 cells/mm3 within the first 9 months of the measurement year? (Y/N)
- If yes, was PCP prophylaxis prescribed within 3 months of CD4<200 cells/mm3? (Y/N)
- If no, was the CD4 count repeated within 3 months? (Y/N)
- If yes, did CD4 count remain < 200 cells/mm3? (Y/N)
- If yes, was PCP prophylaxis prescribed within 3 months of CD4<200 cells/mm3? (Y/N)
- If yes, did CD4 count remain < 200 cells/mm3? (Y/N)
- If no, was the CD4 count repeated within 3 months? (Y/N)
- If yes, was PCP prophylaxis prescribed within 3 months of CD4<200 cells/mm3? (Y/N)
- If yes, did the patient have a CD4 count <200 cells/mm3 within the first 9 months of the measurement year? (Y/N)
- If yes, did the patient have at least two medical visits in the measurement year with at least 90 days between visits? (Y/N)
Numerator/denominator 2:
- Is the patient between 1-5 years old and have a diagnosis of HIV? (Y/N)
- If yes, did the patient have at least two medical visits in the measurement year with at least 90 days between visits? (Y/N)
- If yes, did the patient have a CD4 count <500 cells/mm3 or CD4 percentage < 15% within the first 9 months of the measurement year? (Y/N)
- If yes, was PCP prophylaxis prescribed within 3 months of CD4<200 cells/mm3? (Y/N)
- If no, was the CD4 count repeated within 3 months? (Y/N)
- If yes, did it remain CD4 count <500 cells/mm3 or CD4 percentage < 15%? (Y/N)
- If yes, was PCP prophylaxis prescribed within 3 months of CD4 count
<500 cells/mm3 or CD4 percentage < 15%? (Y/N)
- If yes, was PCP prophylaxis prescribed within 3 months of CD4 count
- If yes, did it remain CD4 count <500 cells/mm3 or CD4 percentage < 15%? (Y/N)
- If no, was the CD4 count repeated within 3 months? (Y/N)
- If yes, was PCP prophylaxis prescribed within 3 months of CD4<200 cells/mm3? (Y/N)
- If yes, did the patient have a CD4 count <500 cells/mm3 or CD4 percentage < 15% within the first 9 months of the measurement year? (Y/N)
- If yes, did the patient have at least two medical visits in the measurement year with at least 90 days between visits? (Y/N)
Numerator/denominator 3:
- Is the patient between 6 weeks and 12 months old and have a diagnosis of HIV? (Y/N)
- If yes, did the patient have at least two medical visits in the measurement year with at least 90 days between visits? (Y/N)
- If yes, was PCP prophylaxis prescribed at HIV diagnosis?
- If yes, did the patient have at least two medical visits in the measurement year with at least 90 days between visits? (Y/N)
***Greater measure specification detail is available including data elements for each value set eCQI Resource Center (funded by the Centers for Medicare and Medicaid Services or CMS) eCQM Resources website. See also Preventive Care and Screening: Screening for Depression and Follow-Up Plan (PDF - 391 KB) (Measure: CMS124v10).
National goals, target, or benchmarks for comparison
The HIV Quality Measures (HIVQM) Module is a tool within the Ryan White HIV/AIDS Services Report portal. It allows recipients to enter aggregate data specific to HRSA HAB Performance Measures. The HIVQM Module allows recipients to conduct point-in-time benchmarking across Ryan White HIV/AIDS Programs that use the module.
Department of Health & Human Services Clinical Practice Guidelines
Adult guidelines
"Adults and adolescents, including pregnant women and those on ART, with CD4 counts <200 cells/mm3 should receive chemoprophylaxis against PCP (AI). Persons who have a CD4 cell percentage of <14% should also be considered for PCP prophylaxis (BII). If ART initiation must be delayed and frequent monitoring of CD4 counts (e.g., every 3 months) is impossible, some experts recommend starting PCP chemoprophylaxis at CD4 counts ≥ 200 cells/mm3 and ≤ 250 cells/mm3 a (BII). Patients receiving pyrimethamine-sulfadiazine for treatment or suppression of toxoplasmosis do not require additional prophylaxis for PCP (AII)."2
Pediatric guidelines
"Chemoprophylaxis is highly effective in preventing PCP. Criteria for its use are based on the patient’s age and CD4 count or percentage (AII). Prophylaxis is recommended for all HIV-infected children aged ≥ 6years who have a CD4 Tlymphocyte (CD4) counts <200 cells/mm3 or CD4 percentage <15% for children aged 1 to years with CD4 counts of <500 cells/mm3 or CD4 percentage <15%, and for all HIV-infected infants aged <12months regardless of CD4 count or percentage.
Infants born to HIV-infected mothers should be considered for prophylaxis beginning at 4–6 weeks of age. HIV-infected infants should be administered prophylaxis until 1 year of age, at which time they should be reassessed on the basis of the age-specific CD4 count or percentage thresholds mentioned above (AII)."3
Use in other federal programs
CMS, Medicare and Medicaid EHR Incentive Program for Eligible Professionals, eCQM Library, Measure CMS124v10. Measure specifications are available online on the eCQM Resources website.
References/notes
1 The HIV/AIDS Bureau did not develop this measure. The National Committee on Quality Assurance developed the measure. Measure details are available online.
2 Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (PDF - 6 MB). Available online. Accessed August 2022. W-2.
3 Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children: Recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Diseases Society of America, and Pediatric Infectious Diseases Society (PDF - 5 MB). Accessed August 2022. W-4.