HEDIS: Quality and Performance Assessment Tool for Healthcare

HEDIS is a quality and performance assessment tool that employs standardized measures set by NCQA. It helps in providing a retrospective look at care and services. This article discusses the Comprehensive Diabetes Care measure and interventions that nursing professionals should take.

Running head: HEDIS
HEDIS
Name of the student:
Name of the university:
Author note:

1
HEDIS
HEDIS can be defined as the quality as well as performance assessment tool that is
required by the Centers for Medicare and Medicaid Services called the CMS. This tool is mainly
seen to employ standardized measures that are set by the National Committee for Quality
Assurance (NCQA) (Laiteerapong et al., 2015). This tool helps in providing a retrospective look
at care as well as other services through different claims, member surveys and medical record
reviews. With the help of this tool, it is seen that the results obtained help to guide the
organization for development of quality initiatives, assessment of performance and effective
building of different educational programs.
As a staff nurse, it is important for the professional to adopt the Comprehensive Diabetes
Care measure. This measure is seen to be helping in the assessments of one thousand patients in
the ward helping in the diagnosis of the diabetes. They may vary from 18 to 75 years of age and
this measure is seen to exclude patients who do not have diagnosis of diabetes. The Hedis
measure of Comprehensive Diabetes care is mainly seen to assess those individuals who have
certain particular symptoms. Therefore, the nurse would be identifying the patients with diabetes
who had undertaken hemoglobin A1c or HbA1c testing and those who have poor control of the
HbA1c above 9.0% (Oster et al., 2015). The individuals who have poor control of HBA1c
control below 8% or eye examination performed or medical attention of nephropathy can be
considered as diabetic. Moreover, when the blood pressure control is less than 140/90 mgHg is
also considered. Eye exam should be performed in both retinal as well as dilated along with
different eye exam codes (Liu et al., 2017).
Some of the interventions that nursing professionals should take is consideration of
sending reminders to patients with information required for testing and other suggestions to set
the appointment, focusing on blood pressure and glucose control, emphasizing importance of

2
HEDIS
yearly eye check up and many others. They can also advice the patient for taking good foot care,
discuss current medication and providing them with current resources for gathering knowledge.
The nurses should also check that whether the patients had completed their HbA1c and
microalbuminuria testing annually and proper charts should be maintained (Kuo et al., 2015).
Once the medical records will be obtained, the professionals will be able to assess the quality of
care that is indeed provided to patients.

3
HEDIS
References:
Kuo, Y.F., Goodwin, J.S., Chen, N.W., Lwin, K.K., Baillargeon, J. and Raji, M.A., 2015.
Diabetes mellitus care provided by nurse practitioners vs primary care
physicians. Journal of the American Geriatrics Society, 63(10), pp.1980-1988.
Laiteerapong, N., Fairchild, P. C., Chou, C. H., Chin, M. H., & Huang, E. S. (2015). Revisiting
disparities in quality of care among US adults with diabetes in the era of individualized
care, NHANES 2007–2010. Medical care, 53(1), 25.
Liu, J., Brown, J., Morton, S., Potter, D.E.B., Patton, L., Patel, M., Lewis, R. and Hudson, S.S.,
2017. Disparities in diabetes and hypertension care for individuals with serious mental
illness. The American journal of managed care, 23(5), pp.304-308.
Oster, G., Moen, D., Yang, T., Dalal, M., Kazemi, M., Sung, J.C., Traylor, L. and Sullivan, S.D.,
2015. Use of Hedis a1c Targets In characterizing treatment Goals In Patients with type 2
Diabetes Mellitus (T2dm) Initiating Basal Insulin. Value in Health, 18(3), p.A70.