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| Performance Measure: HAART - OPR-Related Measure: Yes |
Percentage of clients with AIDS who are prescribed HAART.
Number of clients with AIDS who were prescribed a HAART regimen [ 1 ] within the measurement year.
Number of clients who:
- have a diagnosis of AIDS (history of a CD4 T-cell count below 200 cells/mm3 or other AIDS-defining condition [ 2 ]), and
- had at least one medical visit with a provider with prescribing privileges [ 3 ], i.e. MD, PA, NP in the measurement year.
-
Patients newly enrolled in care during last three months of the measurement year.
- Is the client diagnosed with CDC-defined AIDS? (Y/N)
- If yes, was the client prescribed HAART during the reporting period? (Y/N)
- Ryan White Program Data Report, Section 2, Items 26 and 31 may provide data useful in establishing a baseline for this performance measure
- 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
| TOP |
| National Goals, Targets, or Benchmarks for Comparison |
IHI Goal: 90% [ 4 ]
CDC and HIVRN data consistent that 80% of those in care "eligible for ARVs" on tx. This includes CD4<350 and not just AIDS. [ 5 ] [ 6 ]
National HIVQUAL Data [ 7 ] [ 8 ]
| |
2003 |
2004 |
2005 |
2006 |
| Top 10% |
100.0% |
100.0% |
100.0% |
100.0% |
| Top 25% |
100.0% |
100.0% |
100.0% |
100.0% |
| Median* |
100.0% |
88.9% |
95.7% |
100.0% |
* from HAB data base
| TOP |
| Outcome Measures for Consideration |
-
- Rate of opportunistic infections in the measurement year
- Rate of HIV-related hospitalizations in the measurement year
- Mortality rates
| TOP |
| Basis for Selection and Placement in Group 1 |
"Randomized clinical trials provide strong evidence of improved survival and reduced disease progression by treating symptomatic patients and patients with CD4 T-cell s <200 cells/mm3." [ 9 ]
Measure reflects important aspect of care that significantly impacts survival, mortality and hinders transmission. Data collection is currently feasible and measure has a strong evidence base supporting the use.
| TOP |
| US Public Health Service Guidelines |
"Antiretroviral therapy is recommended for all patients with history of an AIDS-defining illness or severe symptoms of HIV infection regardless of CD4 T-cell count." [ 10 ]
[1] Many authorities recommend two baseline CD4 T-cell measurements before decisions are made to initiate antiretroviral therapy because of wide variations in results. The test should be repeated yet a third time if discordant results are seen. The optimal time to initiate antiretroviral therapy among asymptomatic patients with CD4 T-cell counts >200 cells/mm3 is unknown. This measure focuses strictly on the subset of patients for whom antiretroviral therapy is unequivocally recommended—those with a CD4 T-cell count below 200 cells/mm3 or history of another AIDS-defining condition. Asymptomatic patients with CD4 T-cell counts of 201-350 cells/mm3 should be offered treatment. For asymptomatic patients with CD4 T-cell of >350 cells/mm3 and plasma HIV RNA >100,000 copies/ml most experienced clinicians defer therapy but some clinicians may consider initiating treatment. (See reference 8 below)
[2] AIDS Defining conditions are noted in CDC. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(no. RR-17). (http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm)
[3] A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe ARV therapy.
[4] IHI Measure reads, " Percent of Patients with Appropriate ARV Therapy Management" http://www.ihi.org/IHI/Topics/HIVAIDS/HIVDiseaseGeneral/Measures/
PercentofPatientswithAppropriateARVTherapyManagement.htm
[5] Gebo, JAIDS January 2005, vol. 38, pp. 96-103.
[6] Teshale Abstract #167, CROI 2005.
[7] The National HIVQUAL data may not be directly comparable due to varying exclusions. Indicator definitions can be accessed at http://www.hivguidelines.org/Content.aspx?PageID=53.
[8] http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/
HQNatlAggScrs3Yrs.pdf
[9] "HAART, CD4<200" (http://www.hivguidelines.org/admin/files/
qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf)
[10] Panel on Antiretroviral Guidelines for Adult and Adolescents. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. Department of Health and Human Services. December 1, 2007; p. 9. Available at http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed December 12, 2007.
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