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Validation of data collection for the HEDIS performance measure on chlamydia screening in an MCO.
American Journal of Managed Care 2003; 9(9):585-593.
Wei F, Walsh CM.
Abstract
OBJECTIVE: To determine the validity of calculating the chlamydia Health Plan
Employer Data and Information Set (HEDIS) measure using administrative data
available in a mixed-model managed care organization (MCO). STUDY DESIGN:
Retrospective cohort study. METHODS: A review of International Classification
of Diseases, Ninth Revision (ICD-9), Current Procedural Termin-ology (CPT),
Healthcare Common Procedure Coding System (HCPCS), and National Drug Code
codes and electronic laboratory files in 1998 and a medical chart review
to validate sexual activity and chlamydia testing codes specified by the
National Committee for Quality Assurance (NCQA) in 1999 for the chlamydia
HEDIS 2000 measure. RESULTS: Fewer than 25% of female enrollees with laboratory
evidence of a chlamydia test had a CPT code for chlamydia testing as specified
by the NCQA. Non-pathogen-specific test codes instead of NCQA-specified codes
were used in 1998 to code chlamydia tests. By incorporating electronic laboratory
data into the automated claims-generating process, all chlamydia tests performed
at staff-model clinics were coded. Use of pharmacy dispensing data to identify
contraceptive prescriptions increased the proportion of enrollees classified
as sexually active by 4% to 5% vs documentation of sexual activity using
ICD-9, CPT, and HCPCS codes only. CONCLUSIONS: The MCO quality assurance
specialists examining chlamydia testing rates under HEDIS may want to evaluate
chlamydia testing coding practices in their MCOs to determine whether simple
changes in coding practices may present a more accurate picture of actual
testing practices. The proportion of female enrollees classified as sexually
active using different data available in the staff and network models varied
only slightly.