Mardon R, Renner P, Lee T; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 754.
NCQA, Research and Analysis, 2000 L Street, NW - Suite 500, Washington, DC 20036 Tel. (202) 955-3567 Fax (202) 955-3599
RESEARCH OBJECTIVE: This presentation will include results from recent field tests conducted by the National Committee for Quality Assurance (NCQA) regarding new health plan performance measures for patients with congestive heart failure or chronic atrial fibrillation. These measures are being considered for inclusion in the Health Plan Employer Data and Information Set (HEDIS) reported by Medicare+Choice plans. The field tests were designed to evaluate the validity, reliability, and variability of the measures across health plans, evaluate the data sources available at different types of health plans, and test alternate measure definitions. STUDY DESIGN: The study was a retrospective disease and treatment prevalence study. POPULATION STUDIED: Five Medicare+Choice health plans participated in the field tests by providing patient-level administrative data and medical record abstracts. The participating plans varied in size and geographic location. PRINCIPAL FINDINGS: The first measure tested was entitled Outpatient Management of Heart Failure: Prescription of Beta-Blockers Within 90 Days of Hospital Discharge. The results showed an average performance of 55.5% with a range of 34.4% to 72.7%. Including patients with common relative contra-indications to beta-blockers (e.g. diabetes, asthma, and COPD) increased the size of the eligible population significantly, but had little effect on the measure rates. Excluding patients without drug benefits from the eligible population increased rates by about 5 percent. Plans were able to gather reliable data for this measure from administrative claims and pharmacy systems.The second measure tested was entitled Monitoring of Patients on Warfarin: Quality of Anticoagulation and Frequency of Testing. The results showed that nearly 90 percent of patients on warfarin received sufficiently frequent serum coagulation tests. However only one-third were in control for the entire 90-day test period. Nearly 20 percent had two or more out-of-range results. Plans were able to identify patients with chronic atrial fibrillation from administrative data reliably. However plans varied considerably in their ability to capture laboratory results with administrative data systems. Some captured nearly 100 percent of results while others relied entirely on medical record review for this information. CONCLUSIONS: Based on these results, the beta-blocker measure will be made available for public comment in Spring 2003, the next step towards inclusion in HEDIS. Because of the difficulty in collecting laboratory results, implementation of the anticoagulation measure is being delayed. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Cardiovascular disease is one of the leading causes of death, illness, and medical expenditures in Medicare. High quality care has been defined and measured for certain types of cardiovascular disease for certain sub-populations. However, a great deal is unknown about the variability in the use of many diagnostic, therapeutic, and monitoring services, even in situations where there is a high degree of clinical consensus on appropriate care. This presentation includes new results on the treatment of Medicare+Choice cardiovascular patients that may help improve the use of clinically recommended modalities.
Publication Types:
Keywords:
- Cross-Sectional Studies
- Humans
- Medical Records
- Medicare
- Medicare Part C
- Research Design
- economics
- hsrmtgs
Other ID:
UI: 102275722
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