HEDIS Measures

As a physician practice manager for Dr. Jones, you have just conducted a mock survey of the patient chart data. The data shows that your physician practice is not meeting standards for two HEDIS measures.

Choose 2 HEDIS measures from the list below that must be implemented in a physician practice to improve patient outcomes.
Describe the sources of data needed to conduct the two measures. What source would you use obtain the data? For example, if we were to look at patients receiving a beta blocker after discharge from the hospital, we would obtain data from pharmacy claims.
Using one of the quality improvement models (i.e., Lean, PDSA, or Six Sigma), explain how you would use the model to implement one of the chosen HEDIS measures.
Include information on how the quality initiatives chosen are linked to the rising costs of health care. Consider government mandates that have improved quality initiatives related to implementing the HEDIS measures or added to the burden of increased costs.

NCQA HEDIS Measures
Anti-Depressant Medication Management (AMM)
Yes Assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on their antidepressant medications.
Two rates are reported:
Effective Acute Phase Treatment: Adults who remained on an antidepressant medication for at least 84 days (12 weeks).
Effective Continuation Phase Treatment: Adults who remained on an antidepressant medication for at least 180 days (6 months).
Cervical Cancer Screening:

Assesses women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
Women age 21–64 who had cervical cytology performed every 3 years.
Women age 30–64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years.

Hypertension/Cardiovascular:

Assesses patients who were hospitalized and discharged alive after an acute Myocardial Infarction (heart attack) who received treatment with beta-blockers for six months after discharge.
Assesses patients 18 to 85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled.
Age 18 to 59 whose BP was <140/90
Age 60 to 85 with a diagnosis of diabetes whose BP was <140/90
Age 60 to 85 without a diagnosis of diabetes whose BP was <150/90
Immunization Status:

Adolescents: Assesses adolescents 13 years of age who had one dose of meningococcal vaccine, one Tdap vaccine and the complete human papillomavirus vaccine series by their 13th birthday.
Children: Assessed the percentage of children 2 years of age who had a four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.
Mammograms:

Women age 50 to 74 years who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy.
Non- Recommended PSA:

Assess whether men 70 years of age and older were screened unnecessarily for prostate cancer using prostate-specific antigen (PSA)-based screening.
Osteoporosis Testing and Management in Older Women:

Osteoporosis Testing in Older Women: This survey-based measure assesses women 65–85 years of age who report ever having received a bone density test to check for osteoporosis.
Osteoporosis Management in Women Who Had a Fracture: Assesses women 65–85 years of age who suffered a fracture and who had either a bone mineral density test or a prescription for a drug to treat osteoporosis in the six months after the fracture.