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HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis

CMS Measure ID
CMS52v8
Version
8
NQF Number
Not Applicable
Measure Description

Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis

Initial Population

Initial Population 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

Initial Population 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

Initial Population 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 Statement
Denominator Exclusions

Exclude patients whose hospice care overlaps the measurement period

Numerator Statement

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 Pneumocystis 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 Pneumocystis jiroveci pneumonia (PCP) prophylaxis at the time of diagnosis of HIV.

Numerator Exclusions

Not Applicable

Denominator Exceptions

Denominator Exceptions 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.

Denominator Exceptions 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%.

Denominator Exceptions 3: None

Previous Version
Measure Scoring
Measure Type
Improvement Notation

A higher score indicates better quality

Guidance

Initial Population 1: The CD4 count below 200 cells/mm3 must occur during the first nine months of the year.

Initial Population 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.

Quality ID
160

Specifications

Attachment Size
CMS52v8.html 86.99 KB
CMS52v8.zip 85.12 KB
CMS52v8-TRN.xlsx 22.96 KB

Release Notes

 

Header

  • Updated eCQM version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated NQF number to 'Not Applicable.'

    Measure Section: NQF Number

    Source of Change: Standards Update

  • Updated endorsed by field to 'None.'

    Measure Section: Endorsed By

    Source of Change: Standards Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated rationale statement.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated clinical recommendation statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

 

Logic

  • Updated and created definitions related to CD4 Count Tests to include oral clindamycin and primaquine for population 1 to align with guidelines for this age group.

    Measure Section: Numerator

    Source of Change: ONC Project Tracking System (JIRA): CQM-3146

  • Updated Numerator 3 to align with logic in other numerators that allow for 'Medication, Order' OR 'Medication Active.'

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Replaced definition 'less than 3 month' with 'occurs 3 months or less' in the denominator exceptions for Population 1.

    Measure Section: Denominator Exceptions

    Source of Change: ONC Project Tracking System (JIRA): CQM-3112

  • Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with CQL Style Guide.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MAT) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Hospice Library (Hospice-2.0.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

 

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set (2.16.840.1.113883.3.464.1003.121.12.1004): Renamed to CD4 Count.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113883.3.464.1003.121.12.1005): Renamed to CD4 Percentage.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set HIV 1 (2.16.840.1.113883.3.464.1003.120.12.1004): Added 53 SNOMED CT codes and deleted 1 SNOMED CT code (79019005).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Oral Clindamycin (2.16.840.1.113883.3.464.1003.196.12.1511): Added Oral Clindamycin.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Leucovorin (2.16.840.1.113883.3.464.1003.196.12.1205): Removed Leucovorin.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced Dapsone and Pyrimethamine (2.16.840.1.113883.3.464.1003.196.12.1202) with direct reference code RxNorm code (904170).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added intravenous and parental pentamidine to the Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis (2.16.840.1.113883.3.464.1003.196.12.1076) value set as related to all 3 numerators; Added 2 RxNorm codes (198229, 861601). Added direct reference code 'Primaquine Phosphate 26.3 MG Oral Tablet' (RxNorm Code (904170)) and created 'Oral Clindamycin' (2.16.840.1.113883.3.464.1003.196.12.1511) as related to numerator 1 value set to align with guidelines for this age group.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (JIRA): CQM-3146

  • Replaced Dapsone and Pyrimethamine (2.16.840.1.113883.3.464.1003.196.12.1202) with direct reference code RxNorm code (904170).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code system versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measure Logic and Implementation Guidance document for a list of code system versions used in the eCQM specifications for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMs. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Oct 10, 2019