Healthcare Effectiveness

Rebekah Parke

     The Healthcare Effectiveness Data and Information Set (HEDIS) is a nationally used way of measuring if patients are receiving appropriate care for their specific diagnoses. The HEDIS is used to make comparisons between healthcare plans and among 90% of health plans including PPOs, Medicare and Medicaid (Healthcare Effectiveness Data and Information Set [HEDIS] – Healthy People 2030, n.d.). By using the HEDIS measure, insurance providers can audit the participants’ care to assure that they are receiving the standard treatments.

     In the given example, as a staff nurse in this clinic, I would first start by making a spread sheet to list all the diabetic patients. I understand this would be quite the task since the charts are manual. The paper charts would have to be sorted through and separated for those with diabetic patients. Then the patient information would be entered into the spread sheet.  While I was looking through the charts to sort out the diabetic patients, I would look for records of diabetic care education, blood pressure records, hemoglobin A1c levels, if they have a history of neuropathy, as well as when their last visit at the office was for diabetes management (Kutz et al., 2018).

     Once all the charts were sorted through, I would be able to sort the information with the spread sheet. With technology there are thankfully many ways to sort and organize this information, while keeping it together with the patient, so that trends could be found in what data may be consistently missing. Other trends could be made of how many patients need certain education or screenings. In order to increase HEDIS compliance these patients could then be asked to return for group education or whatever category they may be missing. By using a spread sheet, the information would then be saved and could be accessed and added to at any time, and would be accessible by all of the providers, without having to sort through piles of paper charts.

Resources:

Healthcare Effectiveness Data and Information Set (HEDIS) - Healthy People 2030. (n.d.).  Healthcare Effectiveness Data and Information Set (HEDIS).  https://health.gov/healthypeople/objectives-and-data/data-sources-and-methods/data-sources/healthcare-effectiveness-data-and-information-set-hedisLinks to an external site.

Kutz, T. L., Roszhart, J. M., Hale, M., Dolan, V., Suchomski, G., & Jaeger, C. (2018). Improving comprehensive care for patients with diabetes.  BMJ Open Quality,  7(4).  https://doi.org/10.1136/bmjoq-2017-000101Links to an external site.