HEDIS measures focus on hypertension, asthma

Many patients are poorly managed, tests show

Treatment of chronic disease is moving to the forefront with a new collection of performance measures focusing on asthma and high blood pressure from the National Committee for Quality Assurance (NCQA) in Washington, DC.

The newest version of the Health Plan Employer Data and Information Set (HEDIS), which becomes effective in the year 2000, also mandates reporting of a six-indicator measurement set for control of diabetes and includes indicators on chlamydia screening and counseling about menopause.

Medical groups and health plans will have much room for quality improvement as they address the new performance assessment indicators. For example, about a third of the adult U.S. population has high blood pressure. But in a field test of the new NCQA measure, only 32% to 42% of those with hypertension had their blood pressure under control.

"I think that these measures, particularly the cardiovascular measures, are of historic significance," said Thomas Lee, MD, representing the American College of Cardiology at a recent press conference unveiling the measures. "Probably five to 10 years from now, we are going to look back on this and realize that the introduction of these measures have as much public health significance as almost anything we were involved with in our careers."

The measures also move HEDIS far from its beginnings as indicators focusing mostly on preventive health screening, notes NCQA spokesman Brian Shilling. "With HEDIS 2000, we have a much-approved ability to measure the care that plans are delivering to their sickest patients," he says. "We’re getting a clearer picture of plan performance across the different stages of care."

The new diabetic, asthma, and cardiovascular measures will likely spur health plans to work with clinicians on quality improvement efforts to control these chronic diseases. In fact, physicians may be surprised to find how poorly their patients are managed despite available treatments. Lee said he surveyed his own practice to see how physicians performed on the blood pressure measure, which determines how many hypertensive patients 45 years and older have their blood pressure controlled below 140/90. "There is unbelievable room for improvement," said Lee, who noted that embarrassment over poor performance may become a driving force for change.

Similar failings have led to unnecessary admissions to emergency departments to treat asthma. One asthma indicator will measure whether health plan members are being prescribed appropriate anti-inflammatory medications. The measure focuses on high-risk children and adults — ages 4 to 55.

A second asthma measure tracks emergency department visits for asthma among high-risk patients. "Inhaled corticosteroids are extremely effective in reducing the frequency and severity of asthma attacks, but they are vastly underused," says Shilling.

Two measures relate to STD, menopause

Two measures that relate to women’s health are also significant in their scope and potential impact. Chlamydia is the most common sexually transmitted disease in the United States, affecting some three million people a year. However, 60% to 70% of women with chlamydia experience no symptoms. They are at risk for pelvic inflammatory disease, infertility, or future ectopic pregnancies if not treated.

The new HEDIS measure determines the percentage of sexually active women between 15 and 25 years of age who received an annual test for chlamydia. In NCQA field tests of the measure, on average only 16% of eligible women were screened for the disease.

HEDIS 2000 also uses a patient survey to learn about counseling of perimenopausal women (ages 47 to 57). The survey asks women whether they have talked to a doctor or other health professional about "ways to deal with menopause," and it asks about information they received on the benefits and risks of hormone replacement therapy.

In another development, the Performance Measurement Coordinating Council (PMCC) moved forward by appointing a staff director and agreeing to integrate its measures.

The PMCC is a collaboration of NCQA, the American Medical Accreditation Program of the American Medical Association, and the Joint Commission on Accreditation of Healthcare Organizations. The member groups announced they will merge their expert panels to streamline development of new measures.

This collaborative also will make sure that indicators used to measure performance have parallel criteria and specifications, says Shilling. For example, if they are measuring childhood immunization rates, the three organizations will draw the same sample populations and use the same technical definitions, so health plans and medical groups don’t have to duplicate efforts. "You’ll see measures that are broadly applicable," says Shilling.