Health Resources and Services Administration HIV/AIDS Bureau Performance Measures
Guide for HIV/AIDS Clinical Care, HRSA HIV/AIDS Bureau
June 2012
Chapter Contents
Overview
References
Core Clinical Performance Measures for Adults and Adolescents: Group 1
Core Clinical Performance Measures for Adults and Adolescents: Group 2
Core Clinical Performance Measures for Adults and Adolescents: Group 3
Medical Case Management Performance Measures
Oral Health Services Performance Measures
AIDS Drug Assistance Program Performance Measures
Systems-Level Performance Measures
Overview
Based on input from key stakeholders, the U.S. Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) has created and released six sets of performance measures to be used to monitor quality of care. These measures can be used as defined or can be further modified by the grantee to meet that agency's individual needs. Grantees are encouraged to select measures that are most important to their agencies and the populations they serve. The measures can be used by the Ryan White HIV/AIDS Program, either at the provider or system level. A brief overview of the performance measures is provided below.
The Core Clinical Performance Measures for Adults and Adolescents are offered as a set of indicators for use in monitoring the quality of care provided. Grantees are encouraged to include the core clinical performance measures in their quality management plans. The clinical performance measures are categorized into three groups.
- Group 1 measures provide an excellent start and can serve as a foundation on which to build, especially if a clinical program has no performance measures.
- Group 2 measures are important measures for a robust clinical management program and should be seriously considered.
- Group 3 measures represent areas of care that are considered "best practice," but may lack written clinical guidelines or rely on data that are difficult to collect.
The Medical Case Management Performance Measures target all clients, and focus on two key issues: care plans and medical visits. Medical case management programs are encouraged to utilize the core clinical performance measures as appropriate.
The Oral Health Performance Measures target all clients. The measures are intended for use by programs providing direct oral health services.
The AIDS Drug Assistance Program (ADAP) Measures are intended for use by the ADAP. Four measures are included and target all clients, regardless of age.
The Systems-Level Performance Measures address aspects of access and entry to care and may be utilized by any system or network.
The Pediatric Performance Measures (not reproduced here) address a range of clinical, social, and system issues for programs that serve pediatric clients.
Core Clinical Performance Measures for Adults and Adolescents: Group 1
| Indicator | How Measured |
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| Antiretroviral Therapy for Pregnant Women# | Percentage of pregnant women with HIV infection who were prescribed antiretroviral therapy (ART) |
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| CD4 T-Cell Count# | Percentage of clients with HIV infection who had two or more CD4 T-cell counts performed in the measurement year |
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| Antiretroviral Therapy# | Percentage of clients with AIDS who were prescribed ART |
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| Medical Visits# | Percentage of clients with HIV infection who had two or more medical visits in an HIV care setting in the measurement year |
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| Pneumocystis jiroveci Pneumonia (PCP) Prophylaxis# | Percentage of clients with HIV infection and a CD4 count below 200 cells/µL who were prescribed PCP prophylaxis |
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| Viral Load Monitoring# | Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with a viral load test performed at least every six months during the measurement year |
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| Viral Load Suppression# | Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with viral load below limits of quantification (<200 copies/mL) at last test during the measurement year |
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Core Clinical Performance Measures for Adults and Adolescents: Group 2
| Indicator | How Measured |
|---|
|
| Adherence: Assessment and Counseling# | Percentage of clients with HIV infection on ARVs who were assessed and counseled for adherence two or more times in the measurement year |
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| Cervical Cancer Screening# | Percentage of women with HIV infection who had a Papanicolaou screening in the measurement year |
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| Hepatitis B Vaccination# | Percentage of clients with HIV infection who completed the vaccination series for hepatitis B |
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| Hepatitis B Screening# | Percentage of patients, regardless of age, for whom Hepatitis B screening was performed at least once since the diagnosis of HIV/AIDS or for whom there is documented infection or immunity |
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| Hepatitis C Screening# | Percentage of clients for whom hepatitis C screening was performed at least once since the diagnosis of HIV infection |
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| HIV Risk Counseling | Percentage of clients with HIV infection who received HIV risk counseling within the measurement year |
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| Lipid Screening | Percentage of clients with HIV infection on ART who had a fasting lipid panel in the measurement year |
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| Oral Examination# | Percentage of clients with HIV infection who received an oral examination by a dentist at least once in the measurement year |
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| Syphilis Screening# | Percentage of adult clients with HIV infection who had a test for syphilis performed in the measurement year |
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| Tuberculosis Screening | Percentage of clients with HIV infection who received testing with results documented for latent tuberculosis infection since HIV diagnosis |
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Core Clinical Performance Measures for Adults and Adolescents: Group 3
| Indicator | How Measured |
|---|
|
| Chlamydia Screening | Percentage of clients with HIV infection at risk of sexually transmitted infections who had a test for chlamydia in the measurement year |
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| Gonorrhea Screening | Percentage of clients with HIV infection at risk of sexually transmitted infections who had a test for gonorrhea in the measurement year |
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| Hepatitis/HIV Alcohol Counseling | Percentage of clients with HIV and hepatitis B or hepatitis C infection who received alcohol counseling in the measurement year |
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| Influenza Vaccination | Percentage of clients with HIV infection who have received influenza vaccination in the measurement period |
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| MAC Prophylaxis | Percentage of clients with HIV infection with CD4 count of <50 cells/µL who were prescribed Mycobacterium avium complex prophylaxis in the measurement year |
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| Mental Health Screening# | Percentage of new clients with HIV infection who have had a mental health screening |
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| Pneumococcal Vaccination | Percentage of clients with HIV infection who ever received pneumococcal vaccine |
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| Substance Use Screening# | Percentage of new clients with HIV infection who have been screened for substance use (alcohol and drugs) in the measurement year |
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| Tobacco Cessation Counseling | Percentage of clients with HIV infection who received tobacco cessation counseling in the measurement year |
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| Toxoplasma Screening | Percentage of clients with HIV infection for whom Toxoplasma screening was performed at least once since the diagnosis of HIV infection |
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Medical Case Management Performance Measures
| Indicator | How Measured |
|---|
| Care Plan | Percentage of HIV-infected medical case management clients who had a medical case management care plan developed and/or updated two or more times in the measurement year |
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| Medical Visits | Percentage of HIV-infected medical case management clients who had two or more medical visits in an HIV care setting in the measurement year |
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Oral Health Services Performance Measures
| Indicator | How Measured |
|---|
| Dental and Medical History | Percentage of HIV-infected oral health patients who had a dental and medical health history (initial or updated) at least once in the measurement year |
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| Dental Treatment Plan | Percentage of HIV-infected oral health patients who had a dental treatment plan developed and/or updated at least once in the measurement year |
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| Oral Health Education | Percentage of HIV-infected oral health patients who received oral health education at least once in the measurement year |
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| Periodontal Screening or Examination | Percentage of HIV-infected oral health patients who had a periodontal screen or examination at least once in the measurement year |
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| Phase 1 Treatment Plan Completion | Percentage of HIV-infected oral health patients with a Phase 1 treatment plan that is completed within 12 months |
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AIDS Drug Assistance Program Performance Measures
| Indicator | How Measured |
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| Application Determination | Percent of ADAP applications approved or denied for new ADAP enrollment within 14 days (2 weeks) of ADAP receiving a complete application in the measurement year |
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| Eligibility Recertification | Percentage of ADAP enrollees who are reviewed for continued ADAP eligibility two or more times in the measurement year |
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| Formulary | Percentage of new antiretroviral classes that are included in the ADAP formulary within 90 days of the date of inclusion of new anti-retroviral classes in the DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents in the measurement year |
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| Inappropriate Antiretroviral Regimen Components Resolved by ADAP | Percent of identified inappropriate antiretroviral (ARV) regimen components prescriptions that are resolved by the ADAP program in the measurement year |
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Systems-Level Performance Measures
| Indicator | How Measured |
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| Waiting time for initial access to outpatient/ambulatory medical care | Percentage of Ryan White Program-funded outpatient/ambulatory care organizations in the system/network with a waiting time of 15 or fewer business days for a Ryan White Program-eligible patient to receive an appointment to enroll in outpatient/ambulatory medical care |
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| HIV test results for PLWHA | Percentage of individuals who test positive for HIV who are given their HIV-antibody test results in the measurement year |
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| Disease status at time of entry into care | Percentage of individuals with an AIDS diagnosis at time of initial outpatient/ambulatory medical care visit in the measurement year |
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| Quality management program | Percentage of Ryan White Program-funded clinical organizations with an HIV-specific quality management program in the measurement year |
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| System-level performance | Rate of achievement (percentage of patients) of the performance measurement of interest in the system/network in the measurement year |
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References
- HAB Performance Measures. Rockville, MD: U.S. Department of Health and Human Services (HRSA) HIV/AIDS Program. Accessed May 16, 2011.
