eCQM Title

HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis

eCQM Identifier (Measure Authoring Tool) 52 eCQM Version number 8.1.000
NQF Number Not Applicable GUID 1cdd20de-5de9-4759-8a93-31f1f8baaaa2
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward National Committee for Quality Assurance
Measure Developer National Committee for Quality Assurance
Measure Developer PCPI(R) Foundation (PCPI[R])
Endorsed By None
Description
Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis
Copyright
This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.
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. NCQA 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 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-20178 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 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 MEASURE 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
Although advances in the management of HIV and AIDS diseases have been made, Pneumocystis jiroveci pneumonia (PCP) remains an important complication and cause of morbidity (Centers for Disease Control and Prevention [CDC], 2017). Without PCP prophylaxis, patients with HIV/AIDS are at increased risk of developing PCP, especially when CD4 cell counts falls to 200 cells/mm3-250 cells/mm3 (Kaplan et al., 1998; Phair et al., 1990). Therefore, the CDC recommends PDP prophylaxis for patients with low CD4 counts.  Despite these recommendations, data from a national sample indicates that 1 in 5 patients infected with HIV and at least one CD4 count <200 cells/mm3 did not have a prescription for PCP prophylaxis (Lin et al., 2016).
Clinical Recommendation Statement
HIV -infected adults and adolescents, including pregnant women and those on ART, should receive chemoprophylaxis against PCP if they have CD4 counts <200 cells/mm3 (A1 recommendation). Persons who have a CD4 cell percentage <14% should also be considered for prophylaxis (BII recommendation). Initiation of chemoprophylaxis at CD4 counts between 200 and 250 cells/mm3 also should be considered when starting ART must be delayed and frequent monitoring of CD4 counts, such as every 3 months, is impossible (BII recommendation). Patients receiving pyrimethamine -sulfadiazine for treatment or suppression of toxoplasmosis do not require additional prophylaxis for PCP (AII recommendation) (Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents, 2018).

Chemoprophylaxis  is highly effective in preventing PCP.  Prophylaxis is recommended for all HIV-infected children aged >= 6 years who have CD4 T lymphocyte (CD4) cell counts <200 cells/mm3 or CD4 percentage <15%, for children aged 1 to <6 years with CD4 counts <500 cells/mm3 or CD4 percentage <15%, and for all HIV-infected infants aged <12 months regardless of CD4 count or percentage (AII recommendation). 

HIV-infected infants should be administered prophylaxis until age 1 year, at which time they should be reassessed on the basis of the age-specific CD4 count or percentage thresholds mentioned above (AII recommendation) (Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children, 2013).
Improvement Notation
A higher score indicates better quality
Reference
Buchacz, K., Lau, B., Jing, Y., et al., for the North American AIDS Cohort Collaboration on Research and Design of leDEA. (2016, September 15). Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada, 2000-2010. Journal of Infectious Diseases, 214(6), 862-872.
Reference
Centers for Disease Control and Prevention. (2017). Pneumocystis pneumonia. Retrieved from https://www.cdc.gov/fungal/diseases/pneumocystis-pneumonia/index.html
Reference
Kaplan, J. E., Hanson, D. L., Navin, T. R., et al. (1998). Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus—Infected adolescents and adults in the United States: Reassessment of indications for chemoprophylaxis. Journal of Infectious Diseases, 178, 1126-1132. 
Reference
Lin, X., Garg, S., Mattson, C. L., et al. (2016, November). Prescription of Pneumocystis jiroveci pneumonia prophylaxis in HIV-infected patients. Journal of the International Association of Providers of AIDS Care, 15(6), 455-458.
Reference
Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children.   (2013). Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. Washington, DC: U.S. Department of Health and Human Services. Retrieved from http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf
Reference
Phair, J., Munoz, A., Detels, R., et al. (1990, January 18). The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1: Multicenter AIDS Cohort Study Group. New England Journal of Medicine, 322(3), 161-165.
Definition
None
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.
Transmission Format
TBD
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
Equals Initial Population
Denominator Exclusions
Exclude patients whose hospice care overlaps the measurement period
Numerator
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
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


Measure Set
Not Applicable