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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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College of Pharmacy, University of Michigan, 4260 Plymouth Rd, Ann Arbor, MI 48109, USA.



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.


Retrospective chart review.


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.


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.


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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