| HIV Clinical
Performance Measure: # 3 |
| Stated
Performance Measure: Percentage
of clients [1]
with HIV infection and a CD4+ count below
200/ µL who were prescribed PCP
prophylaxis |
| Numerator: |
Number of
clients with HIV infection who:
- were seen within the measurement
year, and
- had a CD4+ count below 200/µL,
and
- were prescribed PCP prophylaxis at
the time of the CD4+ count below 200/µL
|
| Denominator:
|
Number of clients with
HIV infection who:
- were seen within the measurement
year, and
- had a CD4+ count below 200/µL
|
| Data
Sources: |
- Electronic Medical Record/Electronic
Health Record
- CAREWare, Lab Tracker, or other electronic
data base
- HIVQUAL reports on this measure for
grantee under review
- Medical record data abstraction by
grantee of a sample of records that
is negotiated with the OPR Review Team
|
| National Goals, Targets,
or Benchmarks for Comparison |
- IHI Goal: 90% [2]
- National HIVQUAL Data:
[3]
| |
2003 |
2004 |
2005 |
Top
10% |
100% |
100% |
100% |
Top
25% |
100% |
100% |
100% |
Median* |
93.3% |
90.9% |
92.3% |
*from HAB data base |
| Basis
for Selection: |
| Pneumocystis
pneumonia (PCP) is the most common opportunistic
infection in people with HIV. Without treatment,
over 85% of people with HIV would eventually
develop PCP. It is a major cause of mortality
among persons with HIV infection, yet is
almost entirely preventable and treatable.
PCP almost always affects the lungs, causing
a form of pneumonia. People with CD4+ cell
counts under 200/µL are at greatest
risk of developing PCP. The drugs now used
to prevent and treat PCP include TMP/SMX,
dapsone, pentamidine, and atovaquone. [4]
Before the widespread use
of primary PCP prophylaxis and effective
ART, PCP occurred in 70%--80% of patients
with AIDS. The course of treated PCP was
associated with a mortality rate of between
20% and 40% in persons with profound immunosuppression.
Approximately 90% of cases occurred among
patients with CD4+ T lymphocyte counts
of <200/µL. [5] |
| US Public
Health Guidelines: |
| "HIV-infected
adults and adolescents, including pregnant
women and those on HAART, should receive
chemoprophylaxis against PCP if they have
a CD4+ T lymphocyte count of <200/ µL."
[6]
(6/14/02) |
| References/Notes: |
1For neonates,
please refer to detail sheet for measure
#18. For children ages 1-12, refer to the
PHS Guidelines (Table 11 of reference #6
below), for the age-appropriate CD4+ level
below which prophylaxis should occur.
2 IHI Measure
reads, “Percent of Patients with a
CD4 Cell Count Below 200 cells/mm3 Receiving
Pneumocystis Carinii Pneumonia (PCP) Prophylaxis”
3 (http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf)
4 http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=515
5 Centers
for Disease Control and Prevention. Treating
opportunistic infections among HIV-infected
adults and adolescents: recommendations
from CDC, the National Institutes of Health,
and the HIV Medicine Association/Infectious
Diseases Society of America. MMWR 2004;53(No.
RR-15) ( http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5315a1.htm)
6 Centers
for Disease Control and Prevention. Guidelines
for Preventing Opportunistic Infections
Among HIV-Infected Persons — 2002
Recommendations of the U.S. Public Health
Service and the Infectious Diseases Society
of America. MMWR 2002;51 (No. RR-8) (http://www.cdc.gov/mmwr/PDF/rr/rr5108.pdf
or http://aidsinfo.nih.gov/ContentFiles/OIpreventionGL.pdf) |
