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HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis

Last updated: May 9, 2019

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 Populationinfo-icon 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:

Equals Initial Populationinfo-icon

Denominator Exclusions:

Exclude patients whose hospice care overlaps the measurement period

Numerator Statement:

Numeratorinfo-icon 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 Exceptionsinfo-icon 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

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Previous Version:
Measure Scoring: Proportion
Measure Type: Process
Improvement Notation:

A higher score indicates better quality

Guidance:

Initial Populationinfo-icon 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
Meaningful Measure: Management of Chronic Conditions

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated NQFinfo-icon 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: Numeratorinfo-icon

    Source of Change: ONC Project Tracking System (JIRA)info-icon: CQMinfo-icon-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 exceptionsinfo-icon 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)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) 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 Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • 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 systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. 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

External Resources