Nursing
Applying Measurement Tools
HEDIS is used to measure the performance which is used to compare the health plan performance, access to care and patients' satisfaction. HEDIS has a set of measures and these measures are combined with HEDIS score to provide the health insurance plan with ratings. Consumers use the ratings to understand the quality of health plans, select a plan or switch plans. HEDIS concentrates on elements such as effectiveness of care, access to care, cost of care, health care choices and credible descriptive information regarding health care (McCune, 2016).The health plan also uses the ratings to improve their services.
In the scenario, the physicians want information on quality incentives for patients with diabetes. As the staff nurse, I have the responsibility to find the information and give a report based on the number of diabetic patients and the services they have received with respect to the HEDIS comprehensive diabetes care.
In comprehensive diabetes care, HEDIS is used to gather data and report whether the diabetic patients have received the necessary screening and exams. Using HEDIS, I will report information on comprehensive diabetes care in the following areas;
- Hemoglobin test-normal should be 7.5%
- HbA1c control
- HbA1c poor control
- Blood pressure control-normal should be 140/80mmHg
- Eye exam-retinal or dilated
- Nephropathy screening and care
- LDL cholesterol testing- LDL should be 3 and cholesterol level should be 5mmol/l (McCune, 2016)
I would take this measure in patients aged 18-75 to find out if they receive proper diabetes management to reduce complications like heart diseases, kidney disease, and premature death. The information will help understand the gaps that need to be filled and suggest the treatments and guidance (McCune, 2016).
Reference
McCune, D. (2016). Understanding HEDIS For Ophthalmology. Review of Ophthalmology, 23(8), 22–23. Retrieved from: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=117313870&site=ehost-live
