Healthcare Effectiveness Data and Information Set (HEDIS) is used to assess and review
the effectiveness and quality of care provided within healthcare organizations (Agniel et al.,
2022). It offers guidelines and goals to guide practices into achieving these goals and providing
the best quality care to patients based on the most up-to-date guidelines (Healthcare
Effectiveness Data and Information Set (HEDIS) - Healthy People 2030 | [Link], n.d.). This
tool is used by over 90 percent of healthcare plans nationwide. It requires certain standards to be
met at a specific percentage for practices to receive reimbursement for treatment, rewarding
higher quality care. The HEDIS covers many patient quality indicators, including diabetes
diagnostics and treatment care (Spath, 2018, p. 65).
The HEDIS measures for diabetic care provide the benchmark for quality patient-
centered care, with the goal being to improve patient involvement and outcomes (Healthcare
Effectiveness Data and Information Set (HEDIS) - Healthy People 2030 | [Link], n.d.-b). In
a clinic with a newly introduced electronic health record (EHR), it will be more tedious to go
through one thousand manual historical patient charts and identify all of the diabetic patients, as
compared to using the EHR to populate the patient list automatically. This chart review allows
the opportune time to insert all patient data into the EHR while collecting data specific to the
HEDIS diabetes indicators. Once this process has been completed and all diabetic patients are
identified, the next step would be chart reviews to determine what benchmark standards have
been addressed and missed. These include glycemic control, renal function monitoring, eye
exams, medication compliance, hypertension control, statin therapy, and preventative measures
such as vaccinations (HEDIS MY 2023 Measure Description | NCQA, 2023). The data collected
could be compiled into a run chart to provide visual and understandable quality measurement
results, allowing for quick identification of indicators that are met and need improvement (Perla
et al., 2011). The medical staff would review these indicators to identify areas of success and
those that need improvement. Interventions specific to the practice could improve indicators
needing improvement through collaboration with all medical staff. These steps would improve
patient outcomes and increase reimbursement to the facility.
HEDIS provides evidence-based care standards to improve patient outcomes and allows
medical facilities to develop interventions and policies to reach these benchmarks. This allows
facilities to identify challenges causing indicators to be missed and create interventions that will
increase the quality of care provided to patients (Kutz et al., 2018). When using an EHR, codes
can be written into the programming to prompt medical staff to address the specific indicators
measured by the HEDIS measures, decreasing missed diagnostics and screenings. Diabetic
patient visits should be staggered rather than back-to-back to allow appropriate time to address
and discuss each HEDIS measure (Kutz et al., 2018). The HEDIS is an exceptional tool for
assessing the quality of care provided within an organization and allowing collaboration among
all staff to meet the indicator standards and improve the quality of patient-centered care while
increasing revenue for a cycle of constant improvement.
References
Agniel, D., Martino, S. C., Burkhart, Q., Scholle, S. H., Quigley, D. D., Hambarsoomian, K.,
Orr, N., Maksut, J. L., Darabidian, B., & Elliott, M. N. (2022). Measuring inconsistency
in quality across patient groups to target quality improvement. Medical Care, 60(6), 453–
461. [Link]
Healthcare Effectiveness Data and Information Set (HEDIS) - Healthy People 2030 | [Link].
(n.d.). [Link]
data-sources/healthcare-effectiveness-data-and-information-set-hedis
HEDIS MY 2023 Measure Description | NCQA. (2023). Washington DC: National Committee
for Quality Assurance. [Link]
[Link]
Kutz, T. L., Roszhart, J. M., Hale, M., Dolan, V., Suchomski, G., & Jaeger, C. (2018). Improving
comprehensive care for patients with diabetes. BMJ Open Quality, 7(4),
e000101. [Link]
National Committee for Quality Assurance. (2023). HEDIS measurement year 2023 volume 2
summary table of measures ... - NCQA. HEDIS MEASUREMENT YEAR 2023 VOLUME
2 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES.
[Link]
[Link]
Perla, R. J., Provost, L., & Murray, S. K. (2011). The run chart: a simple analytical tool for
learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46–
51. [Link]
Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health
Administration Press.