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Am J Manag Care. 2010 Jan;16(1):19-24.

New diabetes HEDIS blood pressure quality measure: potential for overtreatment.

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1
College of Pharmacy, University of Michigan, 4260 Plymouth Rd, Ann Arbor, MI 48109, USA. haemi@umich.edu

Abstract

OBJECTIVE:

To examine reasons for failing to meet the new Healthcare Effectiveness Data and Information Set (HEDIS) blood pressure (BP) measure for diabetes patients (BP <130/80 mm Hg), which may not accurately identify poor-quality care and could promote overtreatment through its performance incentives.

STUDY DESIGN:

Retrospective chart review.

METHODS:

We formed 2 cohorts of diabetes patients in 9 general medicine clinics in an academic healthcare system. Cohort A (n = 124) failed the new HEDIS measure but passed the old measure (systolic blood pressure [SBP] 130-139 and diastolic blood pressure [DBP] <90 mm Hg; or SBP <140 and DBP 80-89 mm Hg). Cohort B (n = 125) failed the old measure (SBP > or = 140 and/ or DBP > or = 90). We reviewed medical records to ascertain clinician response to elevated BP.

RESULTS:

Physicians documented treatment changes in only 4% and 28% of cohort A and B patients, respectively. Refractory systolic hypertension was common in those aged > or = 65 years; 60% of those in cohort B and 58% in cohort A took 3 or more antihypertensive medications and/or had a diastolic BP below 70 mm Hg.

CONCLUSIONS:

We identified a substantial cohort of elderly diabetes patients with DBP <70 mm Hg who were on 3 medications at adequate doses, but who did not meet the current performance measurement criteria (140/90 or 130/80 mm Hg). We suggest that such patients be excluded from performance measures, or if included, be noted for special attention by clinicians to balance intensification with risk.

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PMID:
20148601
[Indexed for MEDLINE]
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