HEDIS is a performance improvement tool that compare the health care quality with regional and national performance benchmark. According to National Committee for Quality Assurance’s (NCQA) website, “more than 200 million people are enrolled in plans that report HEDIS.” (HEDIS Measures and Technical Resources, 2022). HEDIS measures are used widely due to important implications in health care industries’ performance measures. Although NCQA established many HEDIS measures for 2023, currently our nursing care services report on eleven measures which are considered equally important to improve quality of patient care in outpatient setting: alcohol, positive alcohol follow-ups, cervical cancer, colon cancer, depression, hypertension, influenza, mammogram, pneumococcal vaccine, PTSD, and tobacco screening.
HEDIS measures are calculated as the division of weighted denominator and weighted numerator scored in percentile. In the electronic health record in our primary care clinics, we have a clinical reminder system which nurses access during the clinical encounter to document assessment data tracked as HEDIS measures. Nursing leadership set a goal to improve performance measures using HEDIS data and dedicated time to identify incomplete clinical reminders through weekly reminders to each primary care team. Primary nurses collaboratively worked together on documenting assessment data through the clinical reminder system which translated to higher performance measures and improved patient outcomes. At the end of the month, HEDIS reports are submitted to the nursing executive leadership for recognition and recommendation on strategic plan for improvement. Comparing the initial data of HEDIS measure established in FY19 to current data of FY22, current data shows significant improvement on public health issues such as alcohol, positive alcohol follow-up, tobacco, depression, PTSD, and hypertension. Evidence-based practice research done by the Substance Abuse and Mental Health Services Administration (SAMHSA) correlation on HEDIS measure and substance abuse. Result indicated HEDIS measures can be used as empirical evidence on effective treatment plan to reduce overdose risk for substance abuse patient (Williams and et.al, 2022).
Nursing team have been analyzing HEDIS data focusing on patient’s health care to optimize quality care in outpatient services. Nursing service took ownership over five composites (alcohol, positive alcohol follow-up, tobacco, depression, and PTSD) of HEDIS measures and continuously meeting the target goal among all outpatient settings under our service in FY22. Collaboration of nursing leadership and front-line nursing staff created a target BP workgroup to meet the AHA EBP target BP since FY19. Nursing leadership had been providing the HEDIS data on BP to identify opportunities for improvement and tracking quality improvement set by AHA EBP target BP (< 149/90). The American Heart Association (AHA) recognized our organization on meeting the AHA EBP target blood pressure criteria for the GOLD+ recognition for the 4th year in a row.
References
1) Williams, A. R., Mauro, C. M., Feng, T., Wilson, A., Cruz, A., Olfson, M., Crystal, S., Samples, H., & Chiodo, L. (2022). Performance measurement for opioid use disorder medication treatment and care retention. American Journal of Psychiatry. https://doi.org/10.1176/appi.a...
2) HEDIS Measures and Technical Resources. (2022). NCQA.org. https://www.ncqa.org/hedis/mea...

Amy Oommen MBA, RN/BSN, BSHS

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