732 • CID 2010:51 (15 September) • HIV/AIDS
H I V / A I D SM A J O R A R T I C L E
Development of National and Multiagency
HIV Care Quality Measures
Michael A. Horberg,1Judith A. Aberg,4Laura W. Cheever,5Philip Renner,6Erin O’Brien Kaleba,7
and Steven M. Asch2,3
1HIV Interregional Initiative, Kaiser Permanente, Oakland, and
at UCLA, and
for Quality Assurance, Washington, DC; and
2VA Greater Los Angeles Healthcare System, David Geffen School of Medicine
4Department of Medicine, New York University School of Medicine, New York,
7Alliance of Chicago Community Health Services, Chicago, Illinois
3RAND Corporation, Los Angeles, California;
5Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland;
(See the editorial commentary by Bozzette, on pages 739–740.)
Human immunodeficiency virus (HIV) is now a complex, chronic disease requiring high quality
care. Demonstration of quality HIV care requires uniform, aligned HIV care quality measurement.
In September 2007, the National Committee for Quality Assurance, under contract with the Health
Resources and Services Administration, the Physician Consortium for Performance Improvement of the American
Medical Association, and HIV Medicine Association of the Infectious Disease Society of America jointly sponsored
and convened an expert panel as a HIV/AIDS Work Group to draft national HIV/AIDS performance measures
for individual patient–level and system-level quality improvement.
A total of 17 measures were developed to assess processes and outcomes of HIV/AIDS care for patients
established in care, defined as having at least 2 visits in a 12-month period; thus, measures of HIV screening,
testing, linkage, and access to care were not included. As a set, the measures assess a wide range of care, including
patient retention, screening and prophylaxis for opportunistic infections, immunization, and initiation and mon-
itoring of potent antiretroviral therapy. Since development, the HIV/AIDS measures’ specifications have been fully
determined and are being beta tested, and a majority have been endorsed by the National Quality Forum and
have been adopted and implemented by the sponsoring organizations.
HIV care quality measurementshouldbeassessedwithgreateruniformity.Themeasurespresented
offer opportunities for such alignment.
Human immunodeficiency virus (HIV)/AIDS has pro-
gressed to a complex, chronic disease since the early
1980s [1, 2]. HIV-infected patients now have greatly
increased life expectancy through the useof appropriate
potent antiretroviral therapy, prophylaxis and/or treat-
ment for opportunistic infections, routinevaccinations,
activities (including safer sex), and retention inmedical
care . However, this care is multifaceted and costly
and requires the coordinated efforts of many health
care professionals [4–7].
Received 27 February 2010; accepted 12 April 2010; electronically published
17 August 2010.
Reprints or correspondence: Dr Michael A. Horberg, HIV/AIDS, Kaiser Permanente
and The Permanente Federation, 2000 Broadway, Oakland, CA 94612 (michael
Clinical Infectious Diseases2010;51(6):732–738
? 2010 by the Infectious Diseases Society of America. All rights reserved.
Many organizations have sought to measure the ef-
fectiveness and quality of their HIV care delivery but
not necessarily in a coordinated, aligned fashion. The
New York State Department of Health AIDS Institute
(NYSAI) developed the HIV Quality of Care Program
in 1992 . This program is responsible for the sys-
tematic monitoring of medical care quality and support
services provided to people infected with HIV in New
York’s hospitals, long-term care facilities, community
health centers, drug treatment programs, community-
based organizations, and most recently, the managed
care HIV Special Need Plans. The measures were de-
veloped, expanded, and maintained by a selected group
of NY State HIV providers and NYSAI staff. Kaiser
Permanente, the largest private provider of HIV care
in the United States, began an HIV care quality mea-
surement and improvement program in 2006, measur-
ing HIV diagnosis, access to and retention in care, care
processes, and outcomes, leading to HIV care quality
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738 • CID 2010:51 (15 September) • HIV/AIDS
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