Table 1.
Health Care Quality and Adherence Measures
| Source | Measure name | Definition | Patient eligibility criteria | Measurement periods |
|---|---|---|---|---|
| NQF16 | HIV Medical Visit Frequency | ≥1 non-diagnostic, non-ER outpatient medical visit for HIV in each 6-month period over a 24-month measurement period, with ≥60 days between visits. | ≥1 non-ER outpatient medical visit for HIV in the first 6 months of the measurement period, with continuous enrollment in the database for the entire measurement period and the 6 months prior. | Assessed between January 1, 2013, and December 31, 2014, and January 1, 2015, and December 31, 2016. |
| Gap in HIV Medical Visits | No absence of a non-diagnostic, non-ER outpatient medical visit for HIV in the second 6 months of a given 12-month measurement period. | ≥1 non-ER outpatient medical visit for HIV in the first 6 months of the measurement period, with continuous enrollment in the database for the entire measurement period and the 6 months prior. | Assessed during each full calendar year of the study (2013, 2014, 2015, 2016). | |
| HIV Viral Load Testinga | HIV viral load test ordered during the 12-month measurement period. | ≥1 non-ER outpatient medical visit for HIV in the first 6 months of the measurement period, with continuous enrollment in the database for the entire measurement period and the 6 months prior. | Assessed during each full calendar year of the study (2013, 2014, 2015, 2016). | |
| Prescription of HIV ART | Prescription for at least 1 ART during a given 12-month measurement period. | ≥1 non-ER outpatient medical visit for HIV in the first 6 months of the measurement period, with continuous enrollment in the database for the entire measurement period and the 6 months prior. | Assessed during each full calendar year of the study (2013, 2014, 2015, 2016). | |
| PQA17 | Adherence to HIV ART | Patients with ≥90% of days covered by an ART regimen in the 12-month measurement period; a variation of this outcome was ≥80% of days covered by an ART regimen. | HIV-1 diagnosis, ≥2 fills of ≥2 distinct ART agents; combination ART drugs were counted as 2 drugs. | Assessed from the date of the first ART regimen prescription fill in the measurement period to the end of the measurement period for each of the 4 full calendar years in the study. |
| CDC14 | Receipt of care | Patients with existing (prevalent) HIV ≥13 years of age with ≥1 viral load or CD4 T-cell test within the 12-month measurement period. | Persons ≥13 years of age at the start of the measurement period, with a non-diagnostic claim for HIV in the 6 months prior to the measurement period, who were continuously enrolled in the database from the date of diagnosis to the end of the measurement period. | Assessed during each full calendar year of the study (2013, 2014, 2015, 2016). |
| Retention in care | Patients with existing (prevalent) HIV ≥13 years of age and ≥2 viral load or CD4 T-cell test, ≥3 months apart, within the 12-month measurement period. | Persons ≥13 years of age at the start of the measurement period, with a non-diagnostic claim for HIV in the 6 months prior to the measurement period, who were continuously enrolled in the database from the date of diagnosis to the end of the measurement period. | Assessed during each full calendar year of the study (2013, 2014, 2015, 2016). | |
| Linkage to care | Newly diagnosed (within the first 3 months of each calendar year; incident patients) patients with HIV ≥13 years of age with ≥1 viral load or CD4 T-cell test within 1 month of the HIV diagnosis date. | Persons ≥13 years of age at the time of diagnosis, with continuous enrollment in the database for the entire measurement period and the 6 months prior. | Assessed during each full calendar year of the study (2013, 2014, 2015, 2016). |
a
This measure was modified from the NQF HIV Viral Load Suppression measure because of the lack of laboratory test results in administrative claims data and reports the proportion of patients who had evidence of a viral load test being performed.
ART, antiretroviral therapy; CDC, Centers for Disease Control and Prevention; ER, emergency room; HIV, human immunodeficiency virus; NQF, National Quality Forum; PQA, Pharmacy Quality Alliance.