E Tables of HIV/AIDS Quality Measures from Selected Sources



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act E Tables of HIV/AIDS Quality Measures from Selected Sources

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act TABLE E-1 Commonly Used Quality Measures by Measure Type Measure Type Measure Source STRUCTURAL MEASURES The committee found no explicit structural measures in use; however, certain process measures such as visits with HIV specialists imply the availability of appropriate health care resources. PROCESS MEASURES Prevention     Counseling and testing HIVQUAL Counseling on high-risk behaviors RAND Tobacco use assessment HIVQUAL Screening & Monitoring   CD4+ cell count HCSUS CD4+ cell count IHI CD4+ cell count UHC CD4+ cell count and HIV viral load FACCT CD4+ cell count and HIV viral load IDSA CD4+ cell count and HIV viral load QUERI CD4+ cell count and HIV viral load RAND CD4+ cell count and HIV viral load RAND CD4+ cell count and HIV viral load UHC Cervical cancer EQHIV

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition Pregnant women The number of pregnant women with counseling offered and testing performed during the prenatal period All Counseled regarding high risk behavior at time of HIV diagnosis and within one month of presentation with an initial infection of STD All Number of patients with whom tobacco use was discussed during the past year All At least one CD4+ cell count determination per studied 6 month interval, by chart review or interview All Percent with CD4+ cell count taken in the past 6 months All Semi-annual CD4+ cell count attainment (most recent 6 months) 1) If CD4+ cell count > 300 cells/µL; 2) If CD4+ cell count <300 cells/µL 1) CD4+ cell count and HIV viral load every 6 months; 2) CD4+ cell count and HIV viral load every 3 months Patients being followed actively (having at least 1 visit in last 6 months) Percent with CD4+ cell count and HIV viral load; every 3–4 months when CD4+ cell count is <350/µL or every 6–7 months when CD4+ cell count is >350/µL 1) Patients on HAART; 2) All 1) CD4+ cell count or HIV viral load test every 3 months; 2) CD4+ cell count or HIV viral load test every 6 months CD4+ cell count > 300 cells/µL Offer of CD4+ test (count or percent) and HIV viral load every 6 months patients with detectable HIV viral loads Offer HIV viral load every 4 months All 1 each (CD4+ cell count and HIV viral load) in 2 consecutive 6-month periods All females Documentation of Pap smear or colposcopy

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Measure Type Measure Source   Cervical cancer EQHIV Cervical cancer FACCT Cervical cancer HCSUS Cervical cancer IDSA Cervical cancer IHI Cervical cancer UHC Cervical cancer and other pelvic disease HIVQUAL Complete blood count FACCT Complete blood count, CD4+ cell count, HIV viral load RAND Complete blood count, CD4+ cell count, HIV viral load RAND Cytomegalovirus disease FACCT Cytomegalovirus disease HCSUS Cytomegalovirus disease RAND Hepatitis A QUERI Hepatitis B FACCT Hepatitis B QUERI Hepatitis B UHC Hepatitis B and C IHI Hepatitis C EQHIV Hepatitis C EQHIV Hepatitis C FACCT

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition Females with abnormal Pap smear Repeat of Pap smear All females Annual Pap smear All females All Pap smears according to guidelines (currently baseline, 6 months, and every 12 months thereafter if normal) HIV-infected adult and adolescent women being followed Percent who had at least one Pap smear done in the past year All females Percent with Pap smear in last 6 months All females Percent with Pap smear (between 9/2000 and 9/2001) All females 18 years or older AND sexually active female patients 13 to 18 years of age Number of patients with a pelvic exam recorded in the last year (pelvic exam includes Pap smear; chlamydia screen; gonorrhea test) All Complete blood count at first visit All Offer baseline laboratories (complete blood count, HIV viral load, CD4+ cell count) within one month of initial diagnosis Patients on antiretroviral therapy Offer CD4+ cell count or percent, HIV viral load and complete blood count within past 4 months 1) All; 2) CD4+ cell count less than 200 cells/µL 1) Cytomegalovirum IgG determination; 2) Annual fundoscopic exam All, as indicated Fundoscopic exam by eye care provider Lowest recorded CD4+ cell count of less than 100 cells/µL Receipt of yearly fundoscopic exam All Receipt of hepatitis A test (ever) All Hepatitis B antibody determination All Receipt of hepatitis B test (ever) All Hepatitis B serology attainment (ever) All Percent with hepatitis B & C screening All Hepatitis C status was known (whether positive or negative) All Appropriate hepatitis C screening All Hepatitis C antibody determination

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Measure Type Measure Source   Hepatitis C HIVQUAL Hepatitis C HIVQUAL Hepatitis C HIVQUAL Hepatitis C QUERI Hepatitis C UHC HIV Specialist Visits HIVQUAL Lipid screening (for disease and drug related metabolic abnormalities) HIVQUAL (optional measure) Lipid screening (for disease and drug related metabolic abnormalities) QUERI Oral Health / Dental exam HIVQUAL (optional measure) Outpatient visits IHI* Outpatient visits EQHIV Syphilis FACCT Syphilis HCSUS Syphilis HIVQUAL Syphilis HIVQUAL Syphilis HIVQUAL

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition All The number of patients for whom hepatitis C was document in the medical record HCV+ patients The number for whom alcohol counseling and HCV education was provided All The number of patients for whom hepatitis A status was documented. All Receipt of hepatitis C test (ever) All Hepatitis C serology attainment (ever) All; with exception of those either incarcerated or hospitalized and with no ambulatory clinic visits during 4-month review period Number of patients who are seen by an HIV specialist at least once every 4 months Patients receiving antiretroviral therapy The number of patients for whom lipid screen was performed during the past year Patients on protease inhibitors (PI) or nonnucleoside reverse transcriptase inhibitors (NNRTI) for consecutive months Receipt of lipid panel testing All The number of patients with a dental exam documented during the past year All Percent with visit(s) in last 3 months All Have outpatient visits in 3 or 4 quarter during review period. All Serologic test for syphilis measured at least once All Any serologic test for syphilis performed All patients 18 years or older AND sexually active patients 13 to 18 years of age The number of patients for whom syphilis screening was performed in the last year Patients with reactive RPR/VDRL Number with RPR/VDRL titer result verified (FTA-ABS) Patients with positive serology Number of patients that have been addressed in the chart

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Measure Type Measure Source   Syphilis QUERI Syphilis RAND Toxoplasmosis FACCT Toxoplasmosis HCSUS Toxoplasmosis QUERI Toxoplasmosis RAND Toxoplasmosis UHC Tuberculosis EQHIV Tuberculosis EQHIV Tuberculosis FACCT Tuberculosis HCSUS Tuberculosis HIVQUAL Tuberculosis IDSA Tuberculosis IHI HIV viral load HCSUS HIV viral load HIVQUAL HIV viral load IHI HIV viral load RAND HIV viral load UHC

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition All Receipt of VDRL test ever All Documented serologic test for syphilis (VDRL or RPR) All Toxoplasma IgG antibody measured at least once All Toxoplasma IgG antibody determination noted in chart All Receipt of toxoplasmosis test (ever) All Toxoplasmosis serology should be documented All Toxoplasmosis serology attainment ever All Documentation of PPD (skin test for TB) during the review period All Documentation of PPD (skin test for TB) during the review period and that it was actually read All PPD (skin test for TB) if no prior positive test All 1) PPD (skin test for TB) ever documented in chart or by interview. 2) periodic PPD tests (skin test for TB) documented in chart or by interview All The number of patients whose PPD (skin test for TB) was placed and results read during the past year HIV-infected persons being followed Percent who had a documented tuberculin skin test at any time All Percent with PPD (skin test for TB) All At least one HIV viral load determination per measured 6 month interval, by chart review or interview All; with exception of those either incarcerated or hospitalized and with no ambulatory clinic visits during 4-month review period The number of patients for whom HIV viral load test was performed every 4 months All Percent with HIV viral load tests taken in past 3 months Patients on antiretroviral therapy Offer HIV viral load measurement within 2 months of initiation or change in antiretroviral treatment All Semi-annual HIV viral load attainment (most recent 6 months)

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Measure Type Measure Source   Treatment (Antiretroviral)   Appropriate management of patients on antiretroviral therapy (ART) HIVQUAL Appropriate management of patients on ART HIVQUAL Appropriate management of patients on ART HIVQUAL Provision of adherence counseling and/or monitoring IHI* Provision of adherence counseling and/or monitoring HIVQUAL Provision of adherence counseling and/or monitoring IHI Provision of adherence counseling and/or monitoring RAND Provision of adherence counseling and/or monitoring UHC Provision of indicated ART IHI*

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition Patients who are receiving ART therapy, received ART therapy in the past, or are eligible for ART therapy based on New York State ART therapy guidelines; virologically stable The number of stable patients for whom HIV viral load is monitored every 4 months Patients who are receiving ART therapy, received ART therapy in the past, or are eligible for ART therapy based on New York State ART therapy guidelines; virologically unstable One of the following four management options is documented in the medical record in every 4-month period that the patient is considered unstable: (1) regimen was changed and HIV viral load assay performed within 8 weeks of decision; (2) justification provided not to change therapy and HIV viral load assay performed within 8 weeks of decision; (3) documentation that patient decides not to take medication and HIV viral load assay performed within 4 months; (4) decision made to discontinue therapy and planned clinical follow-up plan noted in record within 4 months Patients who are receiving ART therapy, received ART therapy in the past, or are eligible for ART therapy based on New York State ART therapy guidelines; end stage or patients with no other therapeutic options The number of patients for whom a follow-up clinic visit is recorded every 4 months Patients on HAART Percent with adherence counseling/intervention at their last visit Patients prescribed antiretroviral therapy Adherence is measured and described quantitatively at least once every 4 months Patients on HAART Percent who self-report adherence to prescribed regimen according to some standard method (3 months) Patients started on protease inhibitors Documented counseling regarding compliance with therapy within 1 month of the start of therapy. Patients on antiretroviral therapy Documentation of adherence to ART at most recent visit All Percent on HAART

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Measure Type Measure Source   Pneumocystis carinii pneumonia (PCP) UHC Toxoplasmosis FACCT Toxoplasmosis RAND Tuberculosis FACCT Tuberculosis RAND Social and Support Services   Benefits advocacy HCSUS Emotional counseling HCSUS

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition Most recent CD4-cell count <200/µL Receipt of PCP prophylaxis Positive antibody (IgG) to toxoplasma present and CD4+ <50 cells/µL Receipt of trimethoprim-sulfamethoxazole, or Dapsone plus pyrimethamine, in recommended doses for recommended duration Patients who do not have active toxoplasmosis and who meet either of the following conditions: Toxo IgG positive; or completion of therapy for active toxoplasmosis Offered toxoplasmosis prophylaxis within 1 month of meeting all these conditions Patients with tuberculin skin test >5ml or prior positive without treatment or contact with active case of tuberculosis Receipt of isoniazid plus pyridoxine or rifampin in recommended doses for recommended duration Patients who do not have active TB and who have not ever previously received TB prophylaxis with current PPD (skin test for TB) >5 mm; or provider noting that patient has had PPD (skin test for TB) >5 mm administered at anytime since HIV diagnosis Offer of tuberculosis prophylaxis within one month of these conditions Patients with a need for help in obtaining income assistance such as SSI, SSDI, AFDC, or health care benefits from Medicaid or the VA in the last 6 months as reported at interview No unmet need Patients with need for help in obtaining mental health or emotional care or counseling in the last 6 months as reported at interview No unmet need

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Measure Type Measure Source   Home Health Services HCSUS Housing HCSUS Mental Health Assessment HIVQUAL Self-management goal setting IHI Substance abuse services HCSUS Substance abuse services HIVQUAL Substance abuse services HIVQUAL Substance abuse services HIVQUAL Support Service IHI OUTCOME MEASURES Health Outcomes     CD4+ cell count IHI CD4+ cell count IHI* CD4+ cell count IHI

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition Patients with need for help in obtaining home health care in the last 6 months as reported at interview No unmet need Patients with a need for help in finding a place to live in the last 6 months as reported at interview No unmet need All The number of patients for whom a mental health assessment was performed during the past year. Assessment components include: cognitive function; screening for depression and anxiety; psychiatric history; psychiatric medication review; psychosocial assessment; sleeping and appetite assessment All Percent with self-management goal setting Patients with need for help in obtaining drug or alcohol treatment in the last 6 months as reported at interview No unmet need All The number of patients with whom substance use was discussed in the past year Patients with current use (0–6 months from date of review) and not in treatment Number for whom referrals are made for substance use treatment Patients with past use (6–24 months from date of review) Number with whom relapse prevention or ongoing treatment has been discussed and substance use within the last 12 months assessed. All Percent with Support Service Assessment All patients with CD4+ cell count in last 3 months Average of the last CD4+ cell count Patients on HAART Percent with CD4+ cell count >200/µL All with at least two CD4+ cell count in last 6 months Percent with CD4+ cell count rise of >50/µL in the past 6 months

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Measure Type Measure Source   CD4+ cell count EQHIV CD4+ cell count EQHIV Emergency room visits UHC Hospitalization UHC Hospitalization IHI HIV viral load IHI* HIV viral load EQHIV HIV viral load EQHIV HIV viral load EQHIV NOTES: 1Treatment regimens were recommended at the time that the studies were done and may be outdated according to current standards. Readers are referred to Department of Health and Human Services and International AIDS Society-USA guidelines for the most current treatment guidelines and recommendations. 2Only indicators for adults and adolescents > 13 were included in this table. 3IHI* denotes a key measure; IHI denotes additional measure. SOURCES: EQHIV = Evaluation of Quality Improvement for HIV Care (Cleary, 2003). FACCT = Foundation for Accountability (Wu and Gifford, 1998; Wu et al., 2000). HCSUS = HIV Cost and Services Utilization Study (Asch, 2003). HIVQUAL = HIV Quality of Care Program (NYSDHAI and HRSA/HAB, 2003). IDSA= Infectious Disease Society of America (Gross et al., 2000). IHI = Institute for Health Care Improvement HIV/AIDS Collaborative (IHI, 2003). QUERI= Quality Enhancement Research Initiative (Anaya, 2003). RAND = The RAND Corporation (Asch et al., 2000). UHC = University Health Consortium (UHC, 2002).

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Eligible Population Measure Criterion/Definition Patients with CD4+ cell count <200/µL CD4+ cell count increased to >200/µL at the last visit All Last CD4+ cell count recorded were <200/µL All Non-injury-related emergency room visits per patient per year UHC categorized this measure under Resource Utilization All Non-injury-related hospitalizations per patient per year UHC categorized this measure under Resource Utilization All Percent with hospitalizations within the last month Patients on HAART Percent with undetectable HIV viral load Patients on HAART (defined as three or more antiretroviral medications) HIV viral load between 0 and 399 copies Patients on HAART (defined as three or more antiretroviral medications) HIV viral load between 400 and 19,999 copies Patients on HAART (defined as three or more antiretroviral medications) HIV viral load > 20,000 copies

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act TABLE E-2 Frequency of Process and Outcome Measures by Source   EQHIV FACCT PREVENTION   Counseling and testing (pregnant women) Counseling on high-risk behaviors Tobacco use assessment SCREENING & MONITORING CD4+ cell count   √ Cervical cancer and other pelvic disease √ √ Complete blood count   √ Cytomegalovirus disease   √ Hepatitis A     Hepatitis B and/or C √ √ HIV specialists visit   Lipid screening Oral health/dental exam Outpatient visits √   Syphilis   √ Toxoplasmosis   √ Tuberculosis √ √ HIV viral load   √ ANTIRETROVIRAL TREATMENT (ART)   Appropriate management of patients on ART Provision of adherence counseling and/or monitoring Provision of indicated ART √ √ Regimen change     PROPHYLACTIC TREATMENT     Hepatitis B   √ Influenza √ √ Mycobacterium avium complex   √ Pneumococcal pneumonia √ Pneumocystis carinii pneumonia √ Toxoplasmosis √ Tuberculosis √ SOCIAL AND SUPPORT SERVICES   Benefits advocacy Emotional counseling Home health services Housing Mental health assessment Self-management goal setting Substance abuse services Support services

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act HCSUS HIVQUAL IDSA IHI QUERI RAND UHC   √     √     √   √   √ √ √ √ √ √ √ √ √   √   √   √   √     √     √   √ √   √   √     √     √       √     √   √ √   √ √   √       √ √ √ √ √ √ √   √ √ √ √ √ √ √   √     √   √   √ √ √   √ √ √ √ √   √     √ √   √   √ √   √   √ √ √ √     √   √ √ √ √ √ √ √ √ √   √   √   √   √ √ √   √     √   √ √     √  

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act   EQHIV FACCT HEALTH OUTCOMES   CD4+ cell count √   Emergency room visits   Hospitalization HIV viral load √   NOTE: No structural quality of care measures were identified in this review. SOURCES: EQHIV = Evaluation of Quality Improvement for HIV Care (Cleary, 2003). FACCT = Foundation for Accountability (Wu and Gifford, 1998; Wu et al., 2000). HCSUS = HIV Cost and Services Utilization Study (Asch, 2003). HIVQUAL = HIV Quality of Care Program (NYSDHAI and HRSA/HAB, 2003). IDSA = Infectious Disease Society of America (Gross et al., 2000). IHI = Institute for Health Care Improvement HIV/AIDS Collaborative (IHI, 2003). QUERI = Quality Enhancement Research Initiative (Anaya, 2003). RAND = The RAND Corporation (Asch et al., 2000). UHC = University Health Consortium (UHC, 2002).

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act HCSUS HIVQUAL IDSA IHI QUERI RAND UHC   √     √   √   √   √  

OCR for page 267
Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act REFERENCES Anaya H. 2003. QUERI Indicators. (Email communication, Henry Anaya, Department of Veterans Affairs, May 12, 2003). Asch S. 2003. Table 2: Adherence to Quality Indicators in HIV. (Email communication, Steven Asch, The RAND Corporation). Asch SM, Kerr EA, Hamilton EG, Reifel JL, McGlynn EA, Editors. 2000. Quality of Care for Oncologic Conditions and HIV: A Review of the Literature and Quality Indicators. Santa Monica, CA: Rand Health. Cleary P. 2003. EQHIV Chart Review Dependent Variables. (Email communication, Paul Cleary, Harvard Medical School, December 9, 2003). Gross PA, Asch S, Kitahata M, Freedberg KA, Barr D, Melnick DA, Bozzette S. 2000. Performance measures for guidelines on preventing opportunistic infections in patients infected with human immunodeficiency virus. Clinical Infectious Diseases 30(Suppl 1):S85–S93. IHI (Institute for Healthcare Improvement). 2003. Improving Care for People Infected with HIV. [Online]. Available: http://www.ihi.org/collaboratives/breakthroughseries/HIV/charter.asp [accessed July 31, 2003]. New York State Department of Health AIDS Institute and Health Resources and Services Administration, HIV/AIDS Bureau (NYSDHAI and HRSA/HAB). 2003. [Online]. Available: http://www.hivguidelines.org/public_html/center/quality-of-care/qoc-ny-indicators.htm. UHC (University Health System Consortium). 2002. HIV Ambulatory Care Clinical Benchmarking Executive Summary. 12. Wu A, Gifford A. 1998. Quality of Care Indicators for HIV/AIDS: A Discussion Paper for the Foundation for Accountability . [Online]. Available: http://www.facct.org/facct/doclibFiles/documentFile_302.pdf [accessed July 31, 2003]. Wu AW, Gifford A, Asch S, Cohn SE, Bozzette SA, Yurk R. 2000. Quality-of-care indicators for HIV/AIDS. Disease Management and Health Outcomes 7(6):315–30.