Highlighting HEDIS Measures for Comprehensive Diabetes Care
Each year, 1.4 million Americans are diagnosed with diabetes. Providers understand that it is a complex and demanding disease and that patients need to have comprehensive care in order to maintain control of their condition.
Measure Definition: This measure looks at several aspects for monitoring and screening patients with diabetes who are 18 to 75 years of age. The measure looks for the percentage of members with type 1 or type 2 diabetes who had each of the following during the year:
- Hemoglobin A1c (HbA1c) testing
- HbA1c poor control (> 9.0%)
- HbA1c control (< 8%)
- HbA1c control (< 7%)
- Eye exam (retinal) performed
- Medical attention for nephropathy
- BP control (< 140/90 mm Hg)
Nationally recognized clinical guidelines recommend:
- HbA1c tests three to four times per year
- Retinal eye exam by an optometrist or ophthalmologist once per year
- Nephropathy screening once per year
- Blood pressure readings at each outpatient medical visit
Reasons for noncompliance:
- Lack of communication and continuity of care between primary care and specialists
- Test results may not have been clearly recorded in the patient's medical chart
- Member with a prescription but no record of an office visit or lab test/result over the course of the year
- Tests may not have been done or recommended
- Establish an office registry to identify your patients with diabetes in order to help track lab test appointments, basic results and specialists. Use this as a tool to improve coordinated care for each patient.
- Be diligent about recording all tests and lab results. Flag high results (HbA1c, blood pressure) and schedule return visits for at-risk members.
- Have MAs scrub charts before all visits in order to identify screening needs. Order tests and have prompts for optometry referrals ready at the time of the visit.
Please contact us with any questions or concerns on this or any other HEDIS measure at HEDIS@modahealth.com.