HAB HIV Performance Measures: 

Systems-Level 

Performance Measure: System-Level Performance 

Rate of achievement (percentage of patients) of the performance measurement of interest* in the 

system/network in the measurement year 

Use of Measure: 

Grantees that provide systems or networks of care, or that fund multiple organizations or providers to deliver 

services must look at the quality of these services across the system of care. This performance measure 

serves as a guide on how to use HAB performance measures at the system-level. 

The system-level rate provides the average likelihood of a patient receiving the quality component within the 

system (answering the question: “How well is the system doing on this measure?”), while the agency-level 

rates provides the likelihood of a patient receiving the quality component within each of the system’s agency 

(answering the question: “How well is each agency doing on this measure?”). These rates (system and 

agency-level) can be used by the system to help establish quality goals and benchmarks, identify quality 

improvement efforts and best practices. 

Example: 

HAB Performance Measure: Medical Visits: 

Percentage of patients with HIV infection who had two or more medical visits in an HIV care setting in the 

measurement year. 

Agency A Agency B Agency C Agency D System-Level Performance 

Numerator 64 365 924 55 1,408 

Denominator 76 452 1,412 112 2,052 

Performance Rate 84% 81% 65% 49% 69% 

Graph of System and agency-level rate of performance: HAB Performance Measure: Medical Visits: 

Agency AAgency BAgency CAgency D System 

84% 81% 

65% 

49% 

69% 

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

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HAB HIV Performance Measures: 

Systems-Level 

Example: 

System A, which has four (4) outpatient/ambulatory medical care organizations, selected the Medical Visits1 

performance measure to examine. Each agency collected and reported to the System A administrator the data 

for all patients which met the HAB performance measure inclusion and exclusion criteria for the defined 

measurement year. The table below shows the reported data. The performance rate for each of the four 

agencies is separately calculated (bottom row). The performance rate for the entire system is also calculated 

by summing the numerators and denominators for the four agencies. (Note: See the FAQs for questions 

regarding calculation of this measure if a representative sampling methodology is used.) 

Basis for Selection: 

Quality management requirements were first introduced in 2000 reauthorization of “Ryan White CARE Act.” 

“Ryan White Treatment and Modernization Act of 2006” (P.L. 109-415) and “Ryan White HIV/AIDS 

Treatment Extension Act of 2009” further delineated these requirements. All RW Program grantees are 

required to establish clinical quality management programs to: 

 Assess the extent to which HIV health services are consistent with the most recent Public Health 

Service guidelines for the treatment of HIV disease and related opportunistic infections; and 

 Develop strategies for ensuring that such services are consistent with the guidelines for improvement 

in the access to and quality of HIV services. 2,3 

The HAB HIV Performance Measures “represent key clinical decision points and should be included as part 

of a quality management program for those providing services to the HIV-infected population. While data are 

not required to be submitted to HAB at this time, grantees are strongly encouraged to track and trend data on 

these measures to monitor the quality of care provided. Grantees are encouraged to identify areas for 

improvement and to include these in their quality management plan. This type of information provides rich 

discussion opportunities with their Project Officers.”4 

US Public Health Service Guidelines: 

See corresponding HAB HIV Performance Measures.* 

References/Notes: 

*Systems/network grantees should select from the HAB HIV performance measures available at: 

http://hab.hrsa.gov/special/habmeasures.htm

1

Medical Visit performance measure: Percentage of clients with HIV infection who had two or more medical 

visits in an HIV care setting in the measurement year. Available at 

http://www.hab.hrsa.gov/special/performance/measureMedVisits.htm. 2

 Public Law 109-415, Ryan White HIV/AIDS Treatment Modernization Act of 2006, 42 USC 201. 

3

Public Law 111-187, Ryan White HIV/AIDS Treatment Extension Act of 2009, 42 USC 201. 

4

 “Quality of Care: HAB Performance Measures Companion Guide ”, accessed at: 

http://hab.hrsa.gov/special/performance/faqData09.htm#data1 on 3 February 2010. 

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