eMeasure Title HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) prophylaxis
eMeasure Identifier
(Measure Authoring Tool)
52 eMeasure Version number 2
NQF Number 0405 GUID 1cdd20de-5de9-4759-8a93-31f1f8baaaa2
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance (NCQA)
Measure Developer National Committee for Quality Assurance (NCQA)/ and American Medical Association - convened Physician Consortium for Performance Improvement (AMA-PCPI)
Endorsed By National Quality Forum
Description
Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis
Copyright
Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]) and the National Committee for Quality Assurance (NCQA). 

These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, 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 commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, NCQA, PCPI nor its members shall be responsible for any use of the Measures. 

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The NCQA, AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. 

CPT(R) contained in the Measure specifications is copyright 2004-2012 American Medical Association. LOINC(R) copyright 2004-2012 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2012 International Health Terminology Standards Development Organisation. ICD-10 copyright 2012 World Health Organization. All Rights Reserved.
Disclaimer
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Although advances in the management of HIV and AIDS diseases have been made, Pneumocystis carinii pneumonia (PCP) remains an important complication and cause of morbidity.  Without PCP prophylaxis, patients with HIV/AIDS are at increased risk of developing PCP, especially when CD4 cell counts fall 200mm3-250mm3 (Kaplan, 1998; Phair, 1990).  PCP prophylaxis is very effective and has been demonstrated to prolong life.   

Data from Kaiser Permanente suggests that a gap exists between what is recommended for patients with HIV infection, and what is actually performed.  According to 2005-2006 data from Kaiser Permanente California (both Northern and Southern), Georgia, and Oregon, only 71% of HIV-infected persons with a CD4<200mm3 received PCP prophylaxis (personal communication, 2007).
Clinical Recommendation Statement
HIV-infected adults and adolescents, including pregnant women and those on HAART, should receive chemoprophylaxis against PCP if they have a CD4+T lymphocyte count of <200/mL or a history of oropharyngeal candidiasis. (USPH/IDSA, 2002)
Improvement Notation
A higher score indicates better quality
Reference
Kaplan JE, Hanson DL, Navin TR, Jones JL. Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus--infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis. The Journal of Infectious Diseases. 1998;178:1126-32.
Reference
Personal communication. Michael Horberg, MD, Director, HIV/AIDS Policy, Quality Improvement, Research, The Permanente Federation. 2007 Nov 6.
Reference
Phair J, Munoz A, Detels R, Kaslow R, Rinaldo C, Saah A. The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. NEJM. 1990 Jan 18;322:161-65.
Definition
None
Guidance
Denominator 1: The CD4 count below 200 cells/mm3 must occur during the first nine months of the year.

Denominator 2: The CD4 count below 500 cells/mm3 or the CD4 percentage below 15% must occur during the first nine months of the year.

Once all denominators and numerators are calculated, a total rate should be calculated using the sum of the three denominators and the sum of the three numerators.
Transmission Format
TBD
Initial Patient Population
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 1-5 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 to 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
Denominator
Equals Initial Patient Population
Denominator Exclusions
None
Numerator
Numerator 1: Patients who were prescribed pneumocystis jiroveci pneumonia (PCP) prophylaxis within 3 months of CD4 count below 200 cells/mm3

Numerator 2: Patients who were prescribed pneumocystic jiroveci pneumonia (PCP) prophylaxis within 3 months of CD4 count below 500 cells/ mm3 or a CD4 percentage below 15%

Numerator 3: Patients who were prescribed Pneumocystic jiroveci pneumonia (PCP) prophylaxis at the time of diagnosis of HIV
Numerator Exclusions
Not Applicable
Denominator Exceptions
Numerator 1: 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 

Numerator 2: 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% 

Numerator 3: None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

Table of Contents


Population criteria

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Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
Not Applicable