Applying HEDIS® Clinical Measures to Community Health Centers: A Feasibility Study

Abstract

Since participation in managed care is critical for community health centers' (CHCs) survival, centers must demonstrate their good performance to purchasers (e.g., state Medicaid agencies) and health plans. Such measures also can contribute to quality improvement. Ideally, the effort would use measures and methods widely recognized in the managed care industry, logically the Health Plan Employer Data and Information Set (HEDIS). This article summarizes a feasibility study of applying HEDIS clinical measures to CHCs as providers. It finds that, with concerted, well-directed efforts, it will be possible to use clinical HEDIS measures in health centers.

Preventive health care measures before and after start of renal replacement therapy

“…This program has been an important and independent source of information on performance of key indicators of the quality of care (QoC) provided by managed care organizations for purchasers of health care 3 . However, these procedures have also been used to evaluate the QoC in non–managed care populations 4–6 …”

Feasibility of Evaluating the CHIPRA Care Quality Measures in Electronic Health Record Data

“…The original specifications of the childhood preventive care measures (Table 1, numbers 6 and 7, [9][10][11][12] are also based on an enrolled population. To calculate these measures for 3-to 6-and 12-to 21-year-olds in EHR data, we suggest defining the denominator as children and youth who have $1 clinic visit in a given measurement year and also had $1 visit in the year prior, to identify "established" clinic patients.…”

“…[8][9][10][11] Health insurance claims data include only services provided during a period of coverage under any given plan. Thus, the CHIPRA measures could compare the quality of care received by people continuously enrolled in one plan, or possibly compare longitudinal data from enrollees in different plans.…”

Measuring Quality in Nurse-Managed Centers Using HEDIS Measures

“…Although HEDIS measures were designed to assess quality in managed care plans, various researchers have tested their application to other healthcare systems. Specific measures have been applied to the ambulatory care services of the Veterans Health Administration medical centers and community health centers (Mencke, Alley, & Etchason, 2000;Zuvekas et al, 1999). HEDIS measures were found to be logical and feasible, with adaptation, for various types of ambulatory care services (Mencke et al; Zuvekas eta].…”