Measuring What Matters Allocation, Planning, and Quality Assessment for the Ryan White CARE Act (2004) / Chapter Skim
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Appendix E: Tables of HIV/AIDS Quality Measures from Selected Sources
Appendix E: Tables of HIV/AIDS Quality Measures from Selected Sources
Pages 267-294
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E Tables of HIV/AIDS Quality Measures from Selected Sources 267
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268 MEASURING WHAT MATTERS TABLE E-1 Commonly Used Quality Measures by Measure Type Measure Type Measure Source STRUCTURAL The committee found no explicit structural measures in MEASURES use; however, certain process measures such as visits with HIV specialists imply the availability of appropriate health care resources. PROCESS MEASURES Prevention Counseling and testing HIVQUAL Counseling on high-risk behaviors RAND Tobacco use assessment HIVQUAL Screening & Monitoring CD4+ cell count HCSUS CD4+ cell count IHI CD4+ cell count UHC CD4+ cell count and HIV viral load FACCT CD4+ cell count and HIV viral load IDSA CD4+ cell count and HIV viral load QUERI CD4+ cell count and HIV viral load RAND CD4+ cell count and HIV viral load RAND CD4+ cell count and HIV viral load UHC Cervical cancer EQHIV
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CD4+ cell count or HIV viral load test every 6 months CD4+ cell count > 300 Offer of CD4+ test (count or percent) and HIV viral cells/µL load every 6 months patients with detectable Offer HIV viral load every 4 months HIV viral loads All 1 each (CD4+ cell count and HIV viral load)
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270 MEASURING WHAT MATTERS TABLE E-1 Continued Measure Type Measure Source Cervical cancer EQHIV Cervical cancer FACCT Cervical cancer HCSUS Cervical cancer IDSA Cervical cancer IHI Cervical cancer UHC Cervical cancer and other pelvic disease HIVQUAL Complete blood count FACCT Complete blood count, CD4+ cell count, RAND HIV viral load Complete blood count, CD4+ cell count, RAND HIV viral load Cytomegalovirus disease FACCT Cytomegalovirus disease HCSUS Cytomegalovirus disease RAND Hepatitis A QUERI Hepatitis B FACCT Hepatitis B QUERI Hepatitis B UHC Hepatitis B and C IHI Hepatitis C EQHIV Hepatitis C EQHIV Hepatitis C FACCT
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All females 18 years or Number of patients with a pelvic exam recorded in the older AND sexually active last year (pelvic exam includes Pap smear; chlamydia female patients 13 to 18 screen; gonorrhea test) years of age All Complete blood count at first visit All Offer baseline laboratories (complete blood count, HIV viral load, CD4+ cell count)
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Lipid screening (for disease and drug QUERI related metabolic abnormalities) Oral Health / Dental exam HIVQUAL (optional measure)
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All Hepatitis C serology attainment (ever) All; with exception of those Number of patients who are seen by an HIV specialist either incarcerated or at least once every 4 months hospitalized and with no ambulatory clinic visits during 4-month review period Patients receiving The number of patients for whom lipid screen was antiretroviral therapy performed during the past year Patients on protease Receipt of lipid panel testing inhibitors (PI)
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274 MEASURING WHAT MATTERS TABLE E-1 Continued Measure Type Measure Source Syphilis QUERI Syphilis RAND Toxoplasmosis FACCT Toxoplasmosis HCSUS Toxoplasmosis QUERI Toxoplasmosis RAND Toxoplasmosis UHC Tuberculosis EQHIV Tuberculosis EQHIV Tuberculosis FACCT Tuberculosis HCSUS Tuberculosis HIVQUAL Tuberculosis IDSA Tuberculosis IHI HIV viral load HCSUS HIV viral load HIVQUAL HIV viral load IHI HIV viral load RAND HIV viral load UHC
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All At least one HIV viral load determination per measured 6 month interval, by chart review or interview All; with exception of those The number of patients for whom HIV viral load test either incarcerated or was performed every 4 months hospitalized and with no ambulatory clinic visits during 4-month review period All Percent with HIV viral load tests taken in past 3 months Patients on antiretroviral Offer HIV viral load measurement within 2 months therapy of initiation or change in antiretroviral treatment All Semi-annual HIV viral load attainment (most recent 6 months) Continued
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Appropriate management of patients on HIVQUAL ART Appropriate management of patients on HIVQUAL ART Provision of adherence counseling and/or IHI* monitoring Provision of adherence counseling and/or HIVQUAL monitoring Provision of adherence counseling and/or IHI monitoring Provision of adherence counseling and/or RAND monitoring Provision of adherence counseling and/or UHC monitoring Provision of indicated ART IHI*
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decision made to discontinue therapy and planned clinical follow-up plan noted in record within 4 months Patients who are receiving The number of patients for whom a follow-up clinic ART therapy, received ART visit is recorded every 4 months therapy in the past, or are eligible for ART therapy based on New York State ART therapy guidelines; end stage or patients with no other therapeutic options Patients on HAART Percent with adherence counseling/intervention at their last visit Patients prescribed Adherence is measured and described quantitatively at antiretroviral therapy least once every 4 months Patients on HAART Percent who self-report adherence to prescribed regimen according to some standard method (3 months) Patients started on Documented counseling regarding compliance with protease inhibitors therapy within 1 month of the start of therapy.
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278 MEASURING WHAT MATTERS TABLE E-1 Continued Measure Type Measure Source Provision of indicated ART EQHIV Provision of indicated ART EQHIV Provision of indicated ART FACCT Provision of indicated ART HCSUS Provision of indicated ART IDSA Provision of indicated ART IHI Provision of indicated ART QUERI Provision of indicated ART RAND
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cells/µL or HIV viral load >20,000 (using RT-PCR) Proportion of patients Receipt of any DHHS recommended combination with indications for antiretroviral regimen during that time period or in the antiretroviral therapy following 3 months according to prevailing DHHS guidelines (CD4-cell count <350/µL or HIV viral load >30,000 at the time of the study)
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FACCT Mycobacterium avium complex (MAC) HCSUS Mycobacterium avium complex (MAC)
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Patient refused was included as having documentation All Receipt of influenza vaccine annually All Receipt of influenza vaccination during the year under study All Monitoring of CD4+ cell counts and HIV HIV viral loads All Receipt of influenza vaccination Patients with a CD4+ cell Taking arithromycin, clarithromycin, or rifabutin in count of less than 50 recommended doses for recommended duration cells/µL Patients with a CD4+ cell Receipt of any CDC/IDSA recommended form of count of less than 50 prophylaxis against Mycobacterium avium complex cells/µL noted in chart or infection interview period in the previous 9 months Patients whose current Percent who have been offered chemoprophylaxis with CD4+ cell count is <50/µL clarithromycin or azithromycin within 2 months of determination that the CD4+ lymphocyte count is <50/µL Patients with CD4+ cell Receipt of at least one MAC drug class in prior count <50/µL 6 months Continued
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UHC Pneumococcal pneumonia FACCT Pneumococcal pneumonia HCSUS Pneumococcal pneumonia IHI Pneumococcal pneumonia RAND Pneumococcal pneumonia UHC Pneumocystis carinii pneumonia (PCP) FACCT Pneumocystis carinii pneumonia (PCP)
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Or oral thrush Aerosolized pentamidine in recommended doses for or fever for 2 weeks recommended duration Patients with a CD4+ cell Receipt of any CDC/IDSA recommended form of count of less than 200 prophylaxis against Pneumocystis carinii cells/µL noted in chart or interview period in the previous 9 months Patients with CD4+ cell The number of patients prescribed PCP prophylactic count <200/µL (patients therapy with CD4+ cell count >200/ µL for less than 6 months are also eligible for review) Patients with CD4+ cell Percent who were prescribed PCP prophylaxis within count currently <200/µL 2 months of determination of the CD4+ cell count to be <200/µL Patients with CD4+ cell Percent with PCP prophylaxis (within last 3 count <200 µL at last visit months)
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284 MEASURING WHAT MATTERS TABLE E-1 Continued Measure Type Measure Source Pneumocystis carinii pneumonia (PCP) UHC Toxoplasmosis FACCT Toxoplasmosis RAND Tuberculosis FACCT Tuberculosis RAND Social and Support Services Benefits advocacy HCSUS Emotional counseling HCSUS
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>5 mm; or provider noting that patient has had PPD (skin test for TB) >5 mm administered at anytime since HIV diagnosis Patients with a need for No unmet need help in obtaining income assistance such as SSI, SSDI, AFDC, or health care benefits from Medicaid or the VA in the last 6 months as reported at interview Patients with need for help No unmet need in obtaining mental health or emotional care or counseling in the last 6 months as reported at interview Continued
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286 MEASURING WHAT MATTERS TABLE E-1 Continued Measure Type Measure Source Home Health Services HCSUS Housing HCSUS Mental Health Assessment HIVQUAL Self-management goal setting IHI Substance abuse services HCSUS Substance abuse services HIVQUAL Substance abuse services HIVQUAL Substance abuse services HIVQUAL Support Service IHI OUTCOME MEASURES Health Outcomes CD4+ cell count IHI CD4+ cell count IHI* CD4+ cell count IHI
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All Percent with Support Service Assessment All patients with CD4+ Average of the last CD4+ cell count cell count in last 3 months Patients on HAART Percent with CD4+ cell count >200/µL All with at least two CD4+ Percent with CD4+ cell count rise of >50/µL in the past cell count in last 6 6 months months Continued
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. IHI = Institute for Health Care Improvement HIV/AIDS Collaborative (IHI, 2003)
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Patients on HAART HIV viral load > 20,000 copies (defined as three or more antiretroviral medications)
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Appropriate management of patients on ART Provision of adherence counseling and/or monitoring Provision of indicated ART Regimen change PROPHYLACTIC TREATMENT Hepatitis B Influenza Mycobacterium avium complex Pneumococcal pneumonia Pneumocystis carinii pneumonia Toxoplasmosis Tuberculosis SOCIAL AND SUPPORT SERVICES Benefits advocacy Emotional counseling Home health services Housing Mental health assessment Self-management goal setting Substance abuse services Support services
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APPENDIX E 291 HCSUS HIVQUAL IDSA IHI QUERI RAND UHC Continued
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. IHI = Institute for Health Care Improvement HIV/AIDS Collaborative (IHI, 2003)
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2002. HIV Ambulatory Care Clinical Benchmarking Executive Summary.
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