eCQM Title | # HIV Screening
eCQM Identifier (Measure Authoring Tool) | 349 | eCQM Version Number | 6.1.000
NQF Number | Not Applicable | GUID | ed78899d-2375-4d68-aa63-58e1734f5694
Measurement Period | January 1, 20XX through December 31, 20XX
Measure Steward | Centers for Disease Control and Prevention (CDC)
Measure Developer | Mathematica
Endorsed By | None
Description |
    Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for Human immunodeficiency virus (HIV)
Copyright |
    Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications.

    CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.
Disclaimer |
    The performance measure is not a clinical guideline and does not establish a standard of medical care, and has 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 |
    HIV is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 34,800 new HIV infections in the United States in 2019 (Centers for Disease Control and Prevention, 2021). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). The Department of Health and Human Services (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022).

    CDC estimates that, at the end of 2016, approximately 14% of the 1.1 million adults and adolescents living with HIV infection in the United States were unaware of their infection (Centers for Disease Control and Prevention, 2019a). Among persons diagnosed with HIV in 2017, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2019c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2019b). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022).

    Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC’s recommendations (Patel et al., 2019).
Clinical Recommendation Statement |
    The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens et al., 2019).

    Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).
Improvement Notation |
    Higher score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'Centers for Disease Control and Prevention. (2021). Estimated HIV incidence and prevalence in the United States, 2015–2019; Table 1, page 19. HIV Surveillance Supplemental Report, 264(1). Retrieved from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html'
Reference |
    Reference Type: CITATION
    Reference Text: 'Centers for Disease Control and Prevention. (2019a). Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report, 24(1). Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-24-1.pdf'
Reference |
    Reference Type: CITATION
    Reference Text: 'Centers for Disease Control and Prevention. (2019b, June). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2017. HIV Surveillance Supplemental Report, 24(3). Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-24-3.pdf'
Reference |
    Reference Type: CITATION
    Reference Text: 'Centers for Disease Control and Prevention. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. Morbidity and Mortality Weekly Report, 55(RR-14), 1-17.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Owens, on behalf of the U.S. Preventive Task Force. (2019). Screening for HIV: US Preventive Services Task Force Recommendation Statement. JAMA, 321(23), 2326-2336.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Panel on Antiretroviral Guidelines for Adults and Adolescents with HIV. (2022). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Retrieved from https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf'
Reference |
    Reference Type: CITATION
    Reference Text: 'Patel, D., Johnson, C.H., Krueger, A. et al. (2019). Trends in HIV Testing Among US Adults, Aged 18–64 Years, 2011–2017. AIDS Behav.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Samji, H., Cescon, A., Hogg, R. S., et al. (2013). Closing the gap: Increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One, 8, e81355.'
Definition |
    None
Guidance |
    This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1].

    This eCQM is a patient-based measure.

    This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Transmission Format |
    TBD
Initial Population |
    Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period
Denominator |
    Equals Initial Population
Denominator Exclusions |
    Patients diagnosed with HIV prior to the start of the measurement period
Numerator |
    Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday
Numerator Exclusions |
    Not Applicable
Denominator Exceptions |
    Patients who die on or before the end of the measurement period
Supplemental Data Elements |
    For every patient evaluated by this measure also identify payer, race, ethnicity and sex

## Table of Contents

- Population Criteria
- Definitions
- Functions
- Terminology
- Data Criteria (QDM Data Elements)
- Supplemental Data Elements
- Risk Adjustment Variables

### Population Criteria

- - Initial Population

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[15, 65]
              and exists "Qualifying Encounters"

- - Denominator

    - -     "Initial Population"

- - Denominator Exclusions

    - -     exists ( ["Diagnosis": "HIV"] HIV
                where HIV.prevalencePeriod starts before start of "Measurement Period"
            )

- - Numerator

    - -     ( "Has HIV Test Performed" )

- - Numerator Exclusions

    - -     None

- - Denominator Exceptions

    - -     exists ( ["Patient Characteristic Expired": "Dead (finding)"] Deceased
                where ToDate(Deceased.expiredDatetime)occurs on or before
                end of "Measurement Period"
            )

- - Stratification

    - -     None

### Definitions

- - Denominator

    - -     "Initial Population"

  - Denominator Exception

    - -     exists ( ["Patient Characteristic Expired": "Dead (finding)"] Deceased
                where ToDate(Deceased.expiredDatetime)occurs on or before
                end of "Measurement Period"
            )

  - Denominator Exclusions

    - -     exists ( ["Diagnosis": "HIV"] HIV
                where HIV.prevalencePeriod starts before start of "Measurement Period"
            )

  - Has HIV Test Performed

    - -     exists ( ["Laboratory Test, Performed": "HIV Lab Tests"]
              union ["Laboratory Test, Performed": "HIV 1 and 2 tests - Meaningful Use set"] ) HIVTest
              where AgeInYearsAt(date from start of Global."NormalizeInterval"(HIVTest.relevantDatetime, HIVTest.relevantPeriod))in Interval[15, 65]
                and Global."NormalizeInterval" ( HIVTest.relevantDatetime, HIVTest.relevantPeriod ) starts before
                end of "Measurement Period"

  - Initial Population

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[15, 65]
              and exists "Qualifying Encounters"

  - Numerator

    - -     ( "Has HIV Test Performed" )

  - Qualifying Encounters

    - -     ( ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
              union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]
              union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
              union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]
              union ["Encounter, Performed": "Office Visit"] ) Encounter
              where Encounter.relevantPeriod during "Measurement Period"

  - SDE Ethnicity

    - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

  - SDE Payer

    - -     ["Patient Characteristic Payer": "Payer"]

  - SDE Race

    - -     ["Patient Characteristic Race": "Race"]

  - SDE Sex

    - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

### Functions

- - Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

    - -     if pointInTime is not null then Interval[pointInTime, pointInTime]
              else if period is not null then period
              else null as Interval<DateTime>

### Terminology

- code "Dead (finding)" ("SNOMEDCT Code (419099009)")
- code "HIV 1 and 2 tests - Meaningful Use set" ("LOINC Code (75622-1)")
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "HIV" (2.16.840.1.113883.3.464.1003.120.12.1003)
- valueset "HIV Lab Tests" (2.16.840.1.113762.1.4.1056.50)
- valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
- valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
- valueset "Payer" (2.16.840.1.114222.4.11.3591)
- valueset "Preventive Care Services Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
- valueset "Preventive Care Services Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
- valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
- valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
- valueset "Race" (2.16.840.1.114222.4.11.836)

### Data Criteria (QDM Data Elements)

- "Diagnosis: HIV" using "HIV (2.16.840.1.113883.3.464.1003.120.12.1003)"
- "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
- "Encounter, Performed: Preventive Care Services Established Office Visit, 18 and Up" using "Preventive Care Services Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
- "Encounter, Performed: Preventive Care Services Initial Office Visit, 18 and Up" using "Preventive Care Services Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
- "Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
- "Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
- "Laboratory Test, Performed: HIV 1 and 2 tests - Meaningful Use set" using "HIV 1 and 2 tests - Meaningful Use set (LOINC Code 75622-1)"
- "Laboratory Test, Performed: HIV Lab Tests" using "HIV Lab Tests (2.16.840.1.113762.1.4.1056.50)"
- "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic Expired: Dead (finding)" using "Dead (finding) (SNOMEDCT Code 419099009)"
- "Patient Characteristic Payer: Payer" using "Payer (2.16.840.1.114222.4.11.3591)"
- "Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
- "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"

### Supplemental Data Elements

- SDE Ethnicity

  - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

- SDE Payer

  - -     ["Patient Characteristic Payer": "Payer"]

- SDE Race

  - -     ["Patient Characteristic Race": "Race"]

- SDE Sex

  - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

### Risk Adjustment Variables

- None

Measure Set |
    NA