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.
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.