Rates for HEDIS Screening for Diabetic Nephropathy Quality Measure May Be Overstated

Area of Science:

• Health Services Research
• Quality Improvement
• Endocrinology

Background:

• The Healthcare Effectiveness Data and Information Set (HEDIS) is crucial for assessing health plan performance.
• Diabetic nephropathy screening is vital for managing diabetes complications.
• Current HEDIS measures assess medical attention for nephropathy in diabetic patients.

Purpose of the Study:

• To evaluate the appropriateness of the prescription drug compliance step within the HEDIS Medical Attention for Nephropathy quality measure.
• To determine if evidence of ACE inhibitors or ARBs accurately reflects nephropathy screening in diabetic patients.

Main Methods:

• Analysis of national commercial claims data for 28,348,363 individuals.
• Application of standard HEDIS specifications for the Medical Attention for Nephropathy measure.
• Evaluation of the third process step: evidence of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).

Main Results:

• The ACE inhibitor/ARB prescription step contributed 14-16% to the numerator, achieving a >80% compliance rate.
• Prescription of ACE inhibitors or ARBs did not confirm the presence of microalbuminuria.
• Only 1% of individuals meeting the ACE inhibitor/ARB criteria had prior microalbuminuria, and none in the reporting year.

Conclusions:

• Including ACE inhibitor/ARB prescriptions as compliance for nephropathy screening leads to overreporting.
• This measure may contribute to the underscreening of diabetic patients at risk for nephropathy.
• Nephropathy screening remains essential despite the use of ACE inhibitors or ARBs.