Clinical Guide > The HIV Clinic > HRSA HAB Performance Measures

# Health Resources and Services Administration HIV/AIDS Bureau Performance Measures

January 2011

### Chapter Contents

      - Overview
      - ReferencesCore Clinical Performance Measures for Adults and Adolescents: Group 1Core Clinical Performance Measures for Adults and Adolescents: Group 2Core Clinical Performance Measures for Adults and Adolescents: Group 3Medical Case Management Performance MeasuresOral Health Services Performance MeasuresAIDS Drug Assistance Program Performance MeasuresSystems-Level Performance MeasuresOverview
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 1IndicatorHow Measured
# Indicates that the HRSA Office of Performance Review (OPR) has selected a performance measure that is similar or the same for use during its site visits (performance reviews) to programs that receive funding from HRSA. The absence of a pound sign indicates that the OPR does not have a corresponding measure. Additional information about the OPR site visit process and list of performance measures can be located on the HAB website. 
Antiretroviral Therapy for Pregnant Women#Percentage of pregnant women with HIV infection who were prescribed antiretroviral therapy (ART)CD4 T-Cell Count#Percentage of clients with HIV infection who had two or more CD4 T-cell counts performed in the measurement yearAntiretroviral Therapy#Percentage of clients with AIDS who were prescribed ARTMedical Visits#Percentage of clients with HIV infection who had two or more medical visits in an HIV care setting in the measurement yearPneumocystis jiroveci Pneumonia (PCP) Prophylaxis#Percentage of clients with HIV infection and a CD4 count below 200 cells/µL who were prescribed PCP prophylaxisCore Clinical Performance Measures for Adults and Adolescents: Group 2IndicatorHow Measured
# Indicates that the HRSA Office of Performance Review (OPR) has selected a performance measure that is similar or the same for use during its site visits (performance reviews) to programs that receive funding from HRSA. The absence of a pound sign indicates that the OPR does not have a corresponding measure. Additional information about the OPR site visit process and list of performance measures can be located on the HAB website. 
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 yearCervical Cancer Screening#Percentage of women with HIV infection who had a Papanicolaou screening in the measurement yearHepatitis B Vaccination#Percentage of clients with HIV infection who completed the vaccination series for hepatitis BHepatitis C Screening#Percentage of clients for whom hepatitis C screening was performed at least once since the diagnosis of HIV infectionHIV Risk CounselingPercentage of clients with HIV infection who received HIV risk counselling within the measurement yearLipid ScreeningPercentage of clients with HIV infection on ART who had a fasting lipid panel in the measurement yearOral Examination#Percentage of clients with HIV infection who received an oral examination by a dentist at least once in the measurement yearSyphilis Screening#Percentage of adult clients with HIV infection who had a test for syphilis performed in the measurement yearTuberculosis ScreeningPercentage of clients with HIV infection who received testing with results documented for latent tuberculosis infection since HIV diagnosisCore Clinical Performance Measures for Adults and Adolescents: Group 3IndicatorHow Measured
# Indicates that the HRSA Office of Performance Review (OPR) has selected a performance measure that is similar or the same for use during its site visits (performance reviews) to programs that receive funding from HRSA. The absence of a pound sign indicates that the OPR does not have a corresponding measure. Additional information about the OPR site visit process and list of performance measures can be located on the HAB website. 
Chlamydia ScreeningPercentage of clients with HIV infection at risk of sexually transmitted infections who had a test for chlamydia in the measurement yearGonorrhea ScreeningPercentage of clients with HIV infection at risk of sexually transmitted infections who had a test for gonorrhea in the measurement yearHepatitis B Screening#Percentage of clients with HIV infection who have been screened for hepatitis B virus infection statusHepatitis/HIV Alcohol CounselingPercentage of clients with HIV and hepatitis B or hepatitis C infection who received alcohol counseling in the measurement yearInfluenza VaccinationPercentage of clients with HIV infection who have received influenza vaccination in the measurement periodMAC Prophylaxis Percentage of clients with HIV infection with CD4 count of <50 cells/µL who were prescribed *Mycobacterium avium* complex prophylaxis in the measurement yearMental Health Screening#Percentage of new clients with HIV infection who have had a mental health screeningPneumococcal VaccinationPercentage of clients with HIV infection who ever received pneumococcal vaccineSubstance Use Screening#Percentage of new clients with HIV infection who have been screened for substance use (alcohol and drugs) in the measurement yearTobacco Cessation CounselingPercentage of clients with HIV infection who received tobacco cessation counseling in the measurement yearToxoplasma ScreeningPercentage of clients with HIV infection for whom Toxoplasma screening was performed at least once since the diagnosis of HIV infectionMedical Case Management Performance MeasuresIndicatorHow MeasuredCare PlanPercentage 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 yearMedical VisitsPercentage of HIV-infected medical case management clients who had two or more medical visits in an HIV care setting in the measurement yearOral Health Services Performance MeasuresIndicatorHow MeasuredDental and Medical HistoryPercentage of HIV-infected oral health patients who had a dental and medical health history (initial or updated) at least once in the measurement yearDental Treatment PlanPercentage of HIV-infected oral health patients who had a dental treatment plan developed and/or updated at least once in the measurement yearOral Health EducationPercentage of HIV-infected oral health patients who received oral health education at least once in the measurement yearPeriodontal Screening or ExaminationPercentage of HIV-infected oral health patients who had a periodontal screen or examination at least once in the measurement yearPhase 1 Treatment Plan CompletionPercentage of HIV-infected oral health patients with a Phase 1 treatment plan that is completed within 12 monthsAIDS Drug Assistance Program Performance MeasuresIndicatorHow MeasuredApplication DeterminationPercent of ADAP applications approved or denied for new ADAP enrollment within 14 days (2 weeks) of ADAP receiving a complete application in the measurement yearEligibility RecertificationPercentage of ADAP enrollees who are reviewed for continued ADAP eligibility two or more times in the measurement yearFormularyPercentage 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 yearInappropriate Antiretroviral Regimen Components Resolved by ADAPPercent of identified inappropriate antiretroviral (ARV) regimen components prescriptions that are resolved by the ADAP program in the measurement yearSystems-Level Performance MeasuresIndicatorHow MeasuredWaiting time for initial access to outpatient/ambulatory medical carePercentage 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 careHIV test results for PLWHAPercentage of individuals who test positive for HIV who are given their HIV-antibody test results in the measurement yearDisease status at time of entry into carePercentage of individuals with an AIDS diagnosis at time of initial outpatient/ambulatory medical care visit in the measurement yearQuality management programPercentage of Ryan White Program-funded clinical organizations with an HIV-specific quality management program in the measurement yearSystem-level performanceRate of achievement (percentage of patients) of the performance measurement of interest in the system/network in the measurement yearReferences- HAB Performance Measures . Rockville, MD: U.S. Department of Health and Human Services (HRSA) HIV/AIDS Program. Accessed May 16, 2011.