HEDIS Comprehensive Diabetes Care

In a healthcare organization which has just recently adopted the electronic health records system, most of the patient information will still be in hard copy. Therefore, to identify the patients with Diabetes, two approaches may be used. The first is claim or encounter data, which includes patients meet the below criteria for the measurement year or the year before (Yoder-Wise, 2015). a) There has been a minimum of two outpatient visits or non-acute inpatient visits on different occasions, which led to the diagnosis of diabetes. b) The must have been at least one acute encounter in the in-patient department which ended with a diabetes diagnosis. c) Lastly, there must have been a minimum of one visit to the Emergency Department resulting in diabetes diagnosis (Spath, 2013).

The second approach is through pharmacy data. During the measurement year, or the year before it, any member who dispensed insulin or the antihyperglycemics frequently will be identified (Perla, Provost & Murray, 2011). This is because these are the prescriptions given to diabetic individuals (Pugh et al., 2013). From this chosen population, the individuals aged 18-75 years by 31st December of the year being measured will be considered. All others will be excluded. After the necessary data has been collected, it is necessary to interpret it so as to enable for an effective comparison meant to identify changes in quality. To do this, a percentage will be calculated by taking the number of all the patients meeting all the HEDIS components, dividing it by total number of diabetics who were cared for, and then multiplying it by 100. The difference in percentage over the years will show whether the clinic has managed to meet its set expectations, and also to identify the areas where there is a need for more improvements.

The total number of patients with Diabetes was 477, which is 47.7% of the patient population. Of this number, only 35.7% met the 8 components of HEDIS comprehensive diabetes care. These members were discharged alive for CABG, they had PCI, were diagnosed with IVD during this year, were tested and diagnosed with thoracic aortic aneurysm, and experienced any of the following; Chronic heart failure, blindness, dementia, amputation, diagnosed with Prior MI and chronic kidney disease. All these factors were present in the files of the 35.7% patients found to have diabetes (Harris et al., 2011).

References

Harris, A. S., Reeder, R. N., Ellerbe, L. S., & Bowe, T. R. (2011). Validation of the treatment identification strategy of the HEDIS addiction quality measures: concordance with medical record review. BMC Health Services Research, 11(1), 73-80. doi:10.1186/1472-6963-11-73

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality and Safety, 20(1), 4651.

Pugh, M., Marcum, Z., Copeland, L., Mortensen, E., Zeber, J., Noel, P., & ... Hanlon, J. (2013). The Quality of Quality Measures: HEDIS Quality Measures for Medication Management in the Elderly and Outcomes Associated with New Exposure. Drugs & Aging, 30(8), 645-654. doi:10.1007/s40266-013-0086-8

Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.

Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Mosby.