Measuring Quality in Nurse-Managed Centers Using HEDIS Measures

Abstract

Nurse-managed centers (NMCs) provide viable options for primary healthcare and contribute substantially to filling access gaps for vulnerable populations. The purposes of this paper are to (a) describe a pilot application and adaptation of eight Health Plan Employer Data and Information Set (HEDIS) measures to six NMCs, (b) report the findings from the quality assessments, and (c) compare findings to national HEDIS data. The eight quality assessment areas are asthma, cervical cancer screening, childhood immunizations, depression, diabetes, hypertension, mammography screening, and smoking cessation. The NMCs achieved or exceeded HEDIS 50th percentile levels in a number of important clinical areas, but did not attain the 50th percentile level in others. Thus, HEDIS measures are relevant for the assessment of care quality and provide useful data for quality improvement in NMCs.

Quality of Care in Nurse-Managed Health Centers

“…5,17,18 The range of achieved quality measures for participating NMHCs was very wide (over 30 percentage points for all outcomes between the lowest and highest measure), indicating a need for individual centers at the low end of the range to examine the quality of their documentation practices and quality of their services. All of the average percentages of achieved quality measures fell within the 50th percentile ranges for HEDIS reports in the same year.…”

“…5 Preventive measures such as smoking advisement and mammograms did not reach the expected 50th percentile benchmark, although with mammograms the centers were very close to the benchmark. One such study 5 involved 6 Michigan NMHCs and included 8 quality assessment areas including common chronic disease management (ie, hypertension, diabetes, depression, and asthma) and common health maintenance categories (breast and cervical cancer screening, childhood immunizations, and smoking assessment and advisement).…”

“…5,20 Variables measured across quality measures included: age as of December 31, 2007; gender (for measures other than breast and cervical cancer screening); race; ethnicity; primary source of health care insurance coverage; and number of visits to the NMHC during a defined period specified by the protocol. Data collection tools were adapted from previous studies.…”

“…One such study 5 involved 6 Michigan NMHCs and included 8 quality assessment areas including common chronic disease management (ie, hypertension, diabetes, depression, and asthma) and common health maintenance categories (breast and cervical cancer screening, childhood immunizations, and smoking assessment and advisement). 5 Although HEDIS measures are based on assumptions that are designed for managed care systems, Barkauskas Findings indicated that, despite very diverse payer mixes, NPs in these practices met or exceeded the HEDIS 50th percentile benchmarks related to chronic disease management (eg, hypertensions, diabetes, and asthma) for the reporting year.…”

Academic Nursing Center Primary Care Quality Improvement Using an Electronic Health Record and a Practice-Based Research Network

“…However, Barkauskas et al [9] offer an explanation as to why the use of HEDIS in NMHCs is challenging, stating that most NMHCs do not have the high patient volume or managed care arrangements characteristic of other types of primary care practices. Additionally, most NMHCs provide more episodic are versus management of chronic health conditions.…”