Accreditation of health plans by the National Committee for Quality Assurance (NCQA) requires their participation in the Healthcare Effectiveness Data and Information Set (HEDIS) projects. The set of 76 HEDIS measures covers a range of health and customer service issues across five areas of practice and is employed by about 90% of US health plans (Spath, 2018). The components of the HEDIS comprehensive diabetes care should be considered because diabetes patients require regular monitoring and medical interventions to prevent complications and achieve favorable health outcomes. The HEDIS measures related to Type 1 and Type 2 diabetes and assessing patients (18-75 years of age) include retinal eye examination, hemoglobin (HbA1c) control, medical attention for nephropathy, and blood pressure control (NCQA, 2021). The measures aim to improve diabetes management and patient compliance with treatment and care provider’s recommendations concerning diet and physical activity.
As a staff nurse working in a small private primary care setting, I would select a run chart as a basic and versatile statistical tool for healthcare data measurement and quality improvement. Perla et al. (2011) suggest that the simple graph might be used to improve patient diabetes control. The collaboration with the physicians and staff members might be helpful for collecting and organizing patient data into a meaningful chart for further review and application. The process of organizing the diabetes-related HEDIS measures into individual charts would help identify the number of diabetes cases from the clinic’s 1,000 patients and assign a physician to each patient. The charts can also reveal signals, or non-random patterns, demonstrating performance improvements or the objective need for changes.
Based on the analysis of quality data, the staff nurse can also calculate the number of patients meeting the components of the HEDIS comprehensive diabetes care. Incentives regarding diabetes patients’ care might be offered to the physicians according to the performance results and goal completion statistics (before and after data) displayed per each indicator. Yoder-Wise (2019) states that the aim of quality management is an improvement, not a blame assignment. Thus, the absence of charts or the lack of progress related to any indicator should result in the collective efforts of leadership and staff to reorganize the clinic’s internal processes instead of applying disciplinary measures. Overall, the introduction of run charts into the private primary care practice can facilitate the management of diabetes cases, evaluate and demonstrate process performance, and understand the state of patient outcomes based on HEDIS measures.
NCQA. (2021). Comprehensive diabetes care (CDC). NCQA. Web.
Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality and Safety, 20(1), 46–51.
Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health Administration Press.
Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). Mosby.