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Study Assesses New HEDIS Blood Pressure Quality Measure for Diabetes


To encourage aggressive treatment of hypertension, the National Committee on Quality Assurance recently adopted a new Healthcare Effectiveness Data and Information Set (HEDIS) blood pressure performance measure of <130/80 mm Hg for patients with diabetes. Although there is nearly universal agreement on the benefits of aggressive BP treatment (3-4 BP medications) for those with diabetes, the new HEDIS performance measure has generated considerable controversy. This retrospective study examined BP levels and medication treatment intensity in patients with diabetes, in order to assess the reasons for failing to meet the new HEDIS measure. Investigators compared electronic medical records for two cohorts receiving primary care in one large academic healthcare system: Cohort A (n=124) - patients with diabetes that failed the new HEDIS measure but passed the old measure (<140/90 mm Hg), and Cohort B (n=125) - patients with diabetes that failed the old measure.

Findings suggest that the new HEDIS diabetes BP measure may not accurately identify poor quality care and could promote overtreatment through its performance incentives. For example, among Cohort B patients, 84% were on at least one antihypertensive medication, and 31% were on three or more, yet failed the old measure. For patients with elevated BPs, physicians documented treatment changes in only 4% of Cohort A patients and in 28% of Cohort B patients. Moreover, the new HEDIS blood pressure measure commonly mislabeled patients as being inadequately treated, especially elderly patients (e.g., most older patients were found to have a diastolic BP of <70 mm Hg and/or to be on three or more antihypertensive medications). Thus, the authors recommend that new BP measures be developed to encourage aggressive treatment of hypertension without unduly promoting overtreatment, especially among elderly patients.

PubMed Logo Choe H, Bernstein S, Standiford C, and Hayward R. New Diabetes HEDIS Blood Pressure Quality Measure: Potential for Overtreatment. The American Journal of Managed Care January 2010;16(1):19-24.

This study was partly funded through VA/HSR&D's Diabetes Mellitus Quality Enhancement Research Initiative (DM-QUERI). Drs. Bernstein and Hayward are part of DM-QUERI.

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HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.