HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis

Last updated: January 31, 2017

CMS Measure ID: CMS52v5
Version: 5
NQF Number: 0405
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 Patient 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:

Equals Initial Population

Denominator Exclusions:

None

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

Measure Steward: National Committee for Quality Assurance
National Quality Strategy Domain: Effective Clinical Care
Previous Version: HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis
Improvement Notation:

A higher score indicates better quality

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.

Specifications

Release Notes

Header

  • Updated Clinical Recommendation Statement.

    Section: Clinical Recommendation Statement

    Source: Measure Lead

  • ‚ÄčUpdated Copyright.

    Section: Copyright

    Source: Annual Update

  • Updated the word 'Numerator' to 'Denominator Exception' to reflect the correct section of the measure.

    Section: Denominator Exceptions

    Source: Measure Lead

  • Updated Disclaimer.

    Section: Disclaimer

    Source: Measure Lead

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated the word 'Denominator' to 'Initial Population' to reflect the correct section of the measure.

    Section: Initial Population

    Source: Measure Lead

  • Capitalized the word Pneumocystis.

    Section: Numerator

    Source: Measure Lead

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

Logic

  • Moved HIV Visit from grouping value set to variable name to increase the visibility of which visits qualify for the measure.

    Section: Initial Population

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Initial Population

    Source: QDM Standards

  • Value set HIV (2.16.840.1.113883.3.464.1003.120.12.1003): Removed HIV.

    Section: Initial Population

    Source: None

  • Value set HIV 1 (2.16.840.1.113883.3.464.1003.120.12.1004 ): Added HIV 1.

    Section: Initial Population

    Source: None

  • Adjusted timing statement to capture the time period specified in the measure description.

    Section: Numerator

    Source: Measure Lead

  • Combined timing for Medication Ordered into one statement to simplify the logic.

    Section: Numerator

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Numerator

    Source: QDM Standards

  • Updated numerator logic to meet QDM standards.

    Section: Numerator

    Source: JIRA (CQM-1797)

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Added Face-to-Face Interaction.

    Section: QDM Data Elements

    Source: None

  • Value set HIV (2.16.840.1.113883.3.464.1003.120.12.1003): Removed HIV.

    Section: QDM Data Elements

    Source: None

  • Value set HIV 1 (2.16.840.1.113883.3.464.1003.120.12.1004 ): Added HIV 1.

    Section: QDM Data Elements

    Source: None

  • Value set HIV Visit (2.16.840.1.113883.3.464.1003.101.12.1047): Removed HIV Visit.

    Section: QDM Data Elements

    Source: None

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added Office Visit.

    Section: QDM Data Elements

    Source: None

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Added Outpatient Consultation.

    Section: QDM Data Elements

    Source: None

  • Value set Preventive Care - Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024): Added Preventive Care - Established Office Visit, 0 to 17.

    Section: QDM Data Elements

    Source: None

  • Value set Preventive Care- Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022): Added Preventive Care- Initial Office Visit, 0 to 17.

    Section: QDM Data Elements

    Source: None

  • Value set Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025): Added Preventive Care Services - Established Office Visit, 18 and Up.

    Section: QDM Data Elements

    Source: None

  • Value set Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023): Added Preventive Care Services-Initial Office Visit, 18 and Up.

    Section: QDM Data Elements

    Source: None

  • Moved HIV Visit from grouping value set to variable name to increase the visibility of which visits qualify for the measure.

    Section: QDM Variables

    Source: Measure Lead

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Added Face-to-Face Interaction.

    Section: QDM Variables

    Source: None

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added Office Visit.

    Section: QDM Variables

    Source: None

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Added Outpatient Consultation.

    Section: QDM Variables

    Source: None

  • Value set Preventive Care - Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024): Added Preventive Care - Established Office Visit, 0 to 17.

    Section: QDM Variables

    Source: None

  • Value set Preventive Care- Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022): Added Preventive Care- Initial Office Visit, 0 to 17.

    Section: QDM Variables

    Source: None

  • Value set Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025): Added Preventive Care Services - Established Office Visit, 18 and Up.

    Section: QDM Variables

    Source: None

  • Value set Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023): Added Preventive Care Services-Initial Office Visit, 18 and Up.

    Section: QDM Variables

    Source: None

Value Set

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Added Face-to-Face Interaction.

    Section: None

    Source: None

  • Value set HIV (2.16.840.1.113883.3.464.1003.120.12.1003): Removed HIV.

    Section: None

    Source: None

  • Value set HIV 1 (2.16.840.1.113883.3.464.1003.120.12.1004 ): Added HIV 1.

    Section: None

    Source: None

  • Value set HIV Visit (2.16.840.1.113883.3.464.1003.101.12.1047): Removed HIV Visit.

    Section: None

    Source: None

  • Value set Leucovorin (2.16.840.1.113883.3.464.1003.196.12.1205): Deleted 1 RXNORM code (250288).

    Section: None

    Source: None

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added Office Visit.

    Section: None

    Source: None

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Added Outpatient Consultation.

    Section: None

    Source: None

  • Value set Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis (2.16.840.1.113883.3.464.1003.196.12.1076): Deleted 1 RXNORM code (197384).

    Section: None

    Source: None

  • Value set Preventive Care - Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024): Added Preventive Care - Established Office Visit, 0 to 17.

    Section: None

    Source: None

  • Value set Preventive Care- Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022): Added Preventive Care- Initial Office Visit, 0 to 17.

    Section: None

    Source: None

  • Value set Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025): Added Preventive Care Services - Established Office Visit, 18 and Up.

    Section: None

    Source: None

  • Value set Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023): Added Preventive Care Services-Initial Office Visit, 18 and Up.

    Section: None

    Source: None

External Resources