HIV/AIDS: Medical Visit

Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]) and the National Committee for Quality Assurance (NCQA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, PCPI, NCQA nor its members shall be responsible for any use of the Measures.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, NCQA and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

In general, patients with early-stage disease are seen at 3-month intervals to undergo routine medical evaluation and monitoring of CD4 cell count, viral load, and CBC. During the initial evaluation more frequent visits are common because there is so much information to transmit. Visits should also be more frequent when therapy is introduced and when the CD4 cell count is <200/mm3 because complications are more likely. (Bartlett, 2004)

Bartlett JG, Cheever LW, Johnson MP, Paauw DS [eds]. A Guide to Primary Care of People with HIV/AIDS. Rockville (MD): US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau; 2004. 167 p. http://hab.hrsa.gov/tools/primarycareguide/ [Accessed August 24, 2007]

New York State Department of Health. Primary care approach to the HIV-infected patient. New York (NY): New York State Department of Health; 2004. 18 p. http://www.hivguidelines.org/Content.aspx?pageID=257 [Accessed August 24, 2007]

A medical visit is any visit with a health care professional who provides routine primary care for the patient with HIV/AIDS (may be but is not limited to a primary care clinician, ob/gyn, pediatrician, infectious disease specialist).

Table of Contents

Initial Patient Population =
- AND: "Encounter, Performed: HIV Visit" during "Measurement Period"
- AND: "Diagnosis, Active: HIV" starts before or during "Measurement Period"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- None
Numerator =
- AND: "Occurrence A of Encounter, Performed: HIV Visit" during "Measurement Period"
- AND: "Occurrence B of Encounter, Performed: HIV Visit" during "Measurement Period"
- AND: "Occurrence B of Encounter, Performed: HIV Visit" >= 90 day(s) starts after end of "Occurrence A of Encounter, Performed: HIV Visit"
Denominator Exceptions =
- None

"Diagnosis, Active: HIV" using "HIV Grouping Value Set (2.16.840.1.113883.3.464.1003.120.12.1003)"
"Encounter, Performed: HIV Visit" using "HIV Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1047)"

None

"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"

Measure Set

Not Applicable

eMeasure Title	HIV/AIDS: Medical Visit
eMeasure Identifier (Measure Authoring Tool)	62	eMeasure Version number	3
NQF Number	Not Applicable	GUID	f70b2984-af4a-4072-ae0d-cec677a7ff8f
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	National Committee for Quality Assurance
Measure Developer	National Committee for Quality Assurance/American Medical Association-convened Physician Consortium for Performance Improvement (R) (AMA-PCPI)
Endorsed By	None
Description	Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with at least two medical visits during the measurement year with a minimum of 90 days between each visit
Copyright	Copyright 2013 National Committee for Quality Assurance (NCQA) and American Medical Association. All Rights Reserved.
Disclaimer	Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]) and the National Committee for Quality Assurance (NCQA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, PCPI, NCQA nor its members shall be responsible for any use of the Measures. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, NCQA and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved. 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	In general, patients with early-stage disease are seen at 3-month intervals to undergo routine medical evaluation and monitoring of CD4 cell count, viral load, and CBC. During the initial evaluation more frequent visits are common because there is so much information to transmit. Visits should also be more frequent when therapy is introduced and when the CD4 cell count is <200/mm3 because complications are more likely. (Bartlett, 2004)
Clinical Recommendation Statement	Clinicians should schedule routine monitoring visits at least every 4 months for all HIV-infected patients who are clinically stable. (NYSDOH, 2004)
Improvement Notation	A higher score indicates better quality
Reference	Bartlett JG, Cheever LW, Johnson MP, Paauw DS [eds]. A Guide to Primary Care of People with HIV/AIDS. Rockville (MD): US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau; 2004. 167 p. http://hab.hrsa.gov/tools/primarycareguide/ [Accessed August 24, 2007]
Reference	New York State Department of Health. Primary care approach to the HIV-infected patient. New York (NY): New York State Department of Health; 2004. 18 p. http://www.hivguidelines.org/Content.aspx?pageID=257 [Accessed August 24, 2007]
Definition	None
Guidance	A medical visit is any visit with a health care professional who provides routine primary care for the patient with HIV/AIDS (may be but is not limited to a primary care clinician, ob/gyn, pediatrician, infectious disease specialist).
Transmission Format	TBD
Initial Patient Population	All patients, regardless of age, with a diagnosis of HIV/AIDS seen within a 12 month period
Denominator	Equals initial patient population
Denominator Exclusions	None
Numerator	Patients with at least two medical visits during the measurement year with a minimum of 90 days between each visit
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Measure Population	Not Applicable
Measure Observations	Not Applicable
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

Table of Contents

Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements