Last updated: June 9, 2017
| CMS Measure ID: | CMS52v6 |
|---|---|
| Version: | 6 |
| 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: |
Exclude patients who were in hospice care during the measurement year |
| 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 |
| Domain: | Effective Clinical Care |
| Previous Version: | HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis |
| 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. |
Specifications
CMS52v6_0.html
CMS52v6_0.xml- CMS52v6_SimpleXML_0.xml
EP_EC_CMS52v6_NQF0405_HIVAIDS_PCP_Prophylaxis_0.zip
CMS52v6_TRN_05.05.17_0.xlsx
Release Notes
Header
Incremented eMeasure Version number.
Section: eMeasure Version number
Source: Measure Lead
Updated Copyright.
Section: Copyright
Source: Annual Update
Updated Disclaimer.
Section: Disclaimer
Source: Measure Lead
Updated Clinical Recommendation Statement to correct a typographical error.
Section: Clinical Recommendation Statement
Source: Measure Lead
Updated Guidance.
Section: Guidance
Source: Measure Lead
Updated the exclusion statement in the header to exclude patients in hospice care from the Denominator. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).
Section: Denominator Exclusions
Source: Measure Lead
Logic
Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.
Section: Denominator Exclusions
Source: Measure Lead
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 HIV 1 (2.16.840.1.113883.3.464.1003.120.12.1004): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.120.11.1005) including 68 codes. Added 1 SNOMEDCT code (713260006).
Section: None
Source: None
Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.
Section: None
Source: None
Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.
Section: None
Source: None
Value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207): Added Discharged to Health Care Facility for Hospice Care.
Section: None
Source: None
Value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209): Added Discharged to Home for Hospice Care.
Section: None
Source: None