HIV Viral SuppressionFHIR - eCQM QICore Content Implementation Guide v2024.0.0

eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024/ and changes regularly. See the Directory of published versions

Measure: HIV Viral SuppressionFHIR

Percentage of patients, regardless of age, diagnosed with HIV prior to or during the first 90 days of the measurement period, with an eligible encounter in the first 240 days of the measurement period, whose last HIV viral load test result was less than 200 copies/mL during the measurement period

UNKNOWN

Official URL: https://madie.cms.gov/Measure/HIVViralSuppressionFHIR		Version: 0.1.000
Draft as of 2024-07-09	Responsible: Health Resources & Services Administration/a>	Computable Name: HIVViralSuppressionFHIR
Other Identifiers: Short Name (use: usual, ), UUID:b8aa1302-d225-4dc7-9a3b-ffec45976a3e (use: official, ), UUID:2e01fe01-f7a8-4765-b439-a9e5af3fda44 (use: official, ), Publisher (use: official, )
Copyright/Legal: This measure was developed by the Health Resources & Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS). It is in the public domain. Citation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA’s original measure. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Title: HIV Viral SuppressionFHIR

Id: HIVViralSuppressionFHIR

Version: 0.1.000

Url: HIV Viral SuppressionFHIR

short-name identifier:

CMS314FHIR

version-independent identifier:

urn:uuid:b8aa1302-d225-4dc7-9a3b-ffec45976a3e

version-specific identifier:

urn:uuid:2e01fe01-f7a8-4765-b439-a9e5af3fda44

publisher (CMS) identifier:

314FHIR

Effective Period: 2025-01-01..2025-12-31

Status: draft

Publisher: Health Resources & Services Administration

Author: Health Resources & Services Administration

Description:

Purpose:

UNKNOWN

Copyright:

This measure was developed by the Health Resources & Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS). It is in the public domain.

Citation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA's original measure.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.

CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Disclaimer:

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Scoring:

Proportion

Rationale:

HIV is a communicable infection that leads to a progressive disease with a long asymptomatic period. Approximately 40,000 persons in the United States are newly infected with HIV each year (Centers for Disease Control and Prevention, 2021, p. 51). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection.

HIV viral suppression is a long-standing priority outcome among the HIV community in the United States and around the world. The National HIV/AIDS Strategy for the United States from 2022-2025, developed by the White House Office of National AIDS Policy with input from the HIV community across the United States, prioritizes increasing HIV viral suppression rates to 95 percent (The White House, 2020). The DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents defines viral suppression as a viral load below the lower limits of detection in its guidelines on virologic failure, and it defines viral suppression as a viral load of less than 200 copies/mL as part of its guidelines for the use of antiretroviral therapy to prevent HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022).

Antiretroviral therapy (ART) delays the progression to AIDS and increases the length of survival. ART reduces HIV-associated morbidity and mortality by maximally inhibiting HIV replication to achieve viral suppression (Hogg et al., 2001; Lundgren et al., 2015). ART has also been shown to reduce transmission of HIV (Rodger et al., 2019). Studies show disparities in rates of viral suppression by race and ethnicity among MSM and among women, with Black and Hispanic or Latino/a study participants having lower rates of viral suppression than White participants (Buchacz et al., 2020; Buchacz et al., 2018; Geter et al., 2018). This measure will help providers direct their attention and quality improvement efforts towards improving HIV viral suppression rates.

Clinical recommendation statement:

Adult guidelines: "The primary goal of antiretroviral therapy (ART) is to prevent HIV-associated morbidity and mortality. This goal is accomplished by using effective ART to achieve and maintain a plasma HIV-1 RNA (viral load) below the quantification limits of commercially available assays. Durable viral suppression improves immune function and overall quality of life, lowers the risk of both AIDS-defining and non-AIDS–defining complications, and allows persons with HIV to live a lifespan approaching that of persons without HIV" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. E-1).

"ART is recommended for all individuals with HIV to reduce the morbidity and mortality associated with HIV infection and to prevent HIV transmission to sexual partners and infants (AI). ART should be initiated as soon as possible after HIV diagnosis (AI)" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. E-2).

"The guidelines and the AIDS Clinical Trials Group (ACTG) now define virologic failure as a confirmed viral load >200 copies/mL- a threshold that eliminates most cases of apparent viremia caused by viral load blips or assay variability" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. C-6).

"Individuals who are adherent to their ARV regimen and do not harbor resistance mutations to the component drugs can generally achieve suppression 8 to 24 weeks after ART initiation; rarely, in some patients it may take longer" (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022, p. C-6).

Pediatric guidelines: "Based on accumulated experience with currently available assays, the current definition of virologic suppression is a plasma viral load below the detection limit of the assay used (generally <20 to 75 copies/mL)" (Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV, 2022, p. D-5).

"Temporary viral load elevations ("blips") that are between the level of detection and 200 copies/mL to 500 copies/mL are often detected in adults and children who are on ART; these temporary elevations do not represent virologic failure, as long as the values have returned to below the level of detection when testing is repeated" (Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV, 2022, p. D-5).

Guidance (Usage): HIV viral load data should be captured either as a numeric value or as a character/text value, depending on whether a given viral load result falls above or below the lab’s lower limit of detection. For viral loads at or above the lower limit of detection, the viral load should be captured as a numeric value (expressed as the number of copies/mL). For viral loads below the lower limit of detection, the viral load should be populated with a character/text value equivalent to "Below lower limit of detection." The EHR need not record this character value using this exact wording (for example, the character value could be recorded as "<20 copies/mL" or "not detected"), but values below the lower limit of detection should be documented to allow the submitter to accurately map them to a value of "Below lower limit of detection" for reporting purposes. HIV viral load test results may be expressed as log values (log copies/mL). For this eCQM, please convert the log value to copies/mL. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS314v2. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)

Population Criteria:

64f8f7aeda013638e7b3d9b2

Initial Population:

All patients, regardless of age, diagnosed with HIV prior to or during the first 90 days of the measurement period with at least one eligible encounter in the first 240 days of the measurement period

Denominator:

Equals Initial Population

Numerator:

Patients with a last HIV viral load test result of less than 200 copies/mL during the measurement period

Supplemental Data Elements:

SDE Ethnicity

SDE Race

SDE Sex

SDE Payer

Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Libraries:

HIVViralSuppressionFHIR

Terminology and Other Dependencies: Library/SupplementalDataElements|3.5.000

Library/FHIRHelpers|4.4.000

Library/QICoreCommon|2.1.000

AdministrativeGender

SNOMED CT (all versions)

HIV Viral Load

HIV

Office Visit

Outpatient Consultation

Annual Wellness Visit

Face-to-Face Interaction

Home Healthcare Services

Preventive Care Services - Established Office Visit, 18 and Up

Preventive Care Services-Initial Office Visit, 18 and Up

Preventive Care Services, Initial Office Visit, 0 to 17

Preventive Care, Established Office Visit, 0 to 17

Telephone Visits

Preventive Care Services - Other

Payer

Parameters:

name

use

min

max

type

Measurement Period

Period

SDE Sex

Out

Coding

Numerator

Out

boolean

Denominator

Out

boolean

SDE Payer

Out

Resource

Initial Population

Out

boolean

SDE Ethnicity

Out

Resource

SDE Race

Out

Resource

DataRequirements:

Resource Type

Resource Elements

Valueset Name

Valueset

Patient(QICorePatient)

ethnicity race

Observation(QICoreObservation)

code effective

HIV Viral Load

Condition(QICoreCondition)

code

HIV

Encounter(QICoreEncounter)

type period

Office Visit

Encounter(QICoreEncounter)

type period

Outpatient Consultation

Encounter(QICoreEncounter)

type period

Annual Wellness Visit

Encounter(QICoreEncounter)

type period

Face-to-Face Interaction

Encounter(QICoreEncounter)

type period

Home Healthcare Services

Encounter(QICoreEncounter)

type period

Preventive Care Services Established Office Visit, 18 and Up

Preventive Care Services - Established Office Visit, 18 and Up

Encounter(QICoreEncounter)

type period

Preventive Care Services Initial Office Visit, 18 and Up

Preventive Care Services-Initial Office Visit, 18 and Up

Encounter(QICoreEncounter)

type period

Preventive Care Services, Initial Office Visit, 0 to 17

Encounter(QICoreEncounter)

type period

Preventive Care, Established Office Visit, 0 to 17

Encounter(QICoreEncounter)

type period

Telephone Visits

Encounter(QICoreEncounter)

type period

Preventive Care Services Other

Preventive Care Services - Other

Coverage(QICoreCoverage)

type period

Payer Type

Payer

Direct Reference Codes:

display

code

system

Male

http://hl7.org/fhir/administrative-gender

Female

http://hl7.org/fhir/administrative-gender

Below threshold level (qualifier value)

260988000

http://snomed.info/sct

Not detected (qualifier value)

260415000

http://snomed.info/sct

Logic Definitions:

Group Scoring Population Criteria Expression

64f8f7aeda013638e7b3d9b2

Group scoring: proportion Measure scoring:

Proportion

Type:

Outcome

Rate Aggregation: None

Improvement Notation:

increase

Initial Population

define "Initial Population":
  "Has Active HIV Diagnosis Before or in First 90 Days of Measurement Period"
    and "Has Qualifying Encounter During First 240 Days of Measurement Period"

Denominator

define "Denominator":
  "Initial Population"

Numerator

define "Numerator":
  "Most Recent Viral Load Test During Measurement Period".value < 200 '{copies}/mL'
    or "Most Recent Viral Load Test During Measurement Period".value ~ "Below threshold level (qualifier value)"
    or "Most Recent Viral Load Test During Measurement Period".value ~ "Not detected (qualifier value)"

Library Name Name

SupplementalDataElements SDE Sex

define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end

Library Name Name

HIVViralSuppressionFHIR SDE Sex

define "SDE Sex":
  SDE."SDE Sex"

Library Name Name

HIVViralSuppressionFHIR Most Recent Viral Load Test During Measurement Period

define "Most Recent Viral Load Test During Measurement Period":
  Last(["Observation": "HIV Viral Load"] ViralLoad
      where ViralLoad.effective.latest() during day of "Measurement Period"
      sort by start of effective.toInterval()
  )

Library Name Name

HIVViralSuppressionFHIR Numerator

define "Numerator":
  "Most Recent Viral Load Test During Measurement Period".value < 200 '{copies}/mL'
    or "Most Recent Viral Load Test During Measurement Period".value ~ "Below threshold level (qualifier value)"
    or "Most Recent Viral Load Test During Measurement Period".value ~ "Not detected (qualifier value)"

Library Name Name

HIVViralSuppressionFHIR Has Active HIV Diagnosis Before or in First 90 Days of Measurement Period

define "Has Active HIV Diagnosis Before or in First 90 Days of Measurement Period":
  exists ["Condition": "HIV"] HIVDx
    where HIVDx.prevalenceInterval ( ) starts before day of ( start of "Measurement Period" + 90 days )

Library Name Name

HIVViralSuppressionFHIR Has Qualifying Encounter During First 240 Days of Measurement Period

define "Has Qualifying Encounter During First 240 Days of Measurement Period":
/*Note: applied workaround using value set 'Preventive Care Services Other', as a DRC cannot be used directly from an encounter retrieve; additional info can be found in CQLIT-368*/
  
  exists ( ["Encounter": "Office Visit"]
    union ["Encounter": "Outpatient Consultation"]
    union ["Encounter": "Annual Wellness Visit"]
    union ["Encounter": "Face-to-Face Interaction"]
    union ["Encounter": "Home Healthcare Services"]
    union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
    union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
    union ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
    union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"]
    union ["Encounter": "Telephone Visits"]
    union ["Encounter": "Preventive Care Services Other"] ) QualifyingEncounter
    where QualifyingEncounter.period during day of Interval[start of "Measurement Period", start of "Measurement Period" + 240 days]

Library Name Name

HIVViralSuppressionFHIR Initial Population

define "Initial Population":
  "Has Active HIV Diagnosis Before or in First 90 Days of Measurement Period"
    and "Has Qualifying Encounter During First 240 Days of Measurement Period"

Library Name Name

HIVViralSuppressionFHIR Denominator

define "Denominator":
  "Initial Population"

Library Name Name

SupplementalDataElements SDE Payer

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

Library Name Name

HIVViralSuppressionFHIR SDE Payer

define "SDE Payer":
  SDE."SDE Payer"

Library Name Name

SupplementalDataElements SDE Ethnicity

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

Library Name Name

HIVViralSuppressionFHIR SDE Ethnicity

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

Library Name Name

SupplementalDataElements SDE Race

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

Library Name Name

HIVViralSuppressionFHIR SDE Race

define "SDE Race":
  SDE."SDE Race"

Library Name Name

QICoreCommon latest

/*
@description: Given an interval, returns the ending point if the interval has an ending boundary specified,
otherwise, returns the starting point
*/
define fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasEnd"()) then end of period
      else start of period

Library Name Name

QICoreCommon prevalenceInterval

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

Library Name Name

FHIRHelpers ToString

define function ToString(value uri): value.value

Library Name Name

FHIRHelpers ToCode

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }