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To provide health care of high quality, hospitals and other healthcare facilities should follow health plans approved by the National Committee on Quality Assurance (NCQA). These accredited plans are supposed to join the Healthcare Effectiveness Data and Information Set (HEDIS) measurement project (Spath, 2013). Measures provided by HEDIS govern many health and customer service aspects. For example, HEDIS provides guidance for comprehensive diabetes care. Even in conditions of small primary care practice, it is important to manage the quality of care and possible risks (Yoder-Wise, 2015). Moreover, the measurement and evaluation of performance should be provided (Spath, 2013). HEDIS components can be applied for quality measurement purposes.
Finding out the Number of Diabetics in Our Practice
As the staff nurse in a primary care practice, I am in charge of patient care in our facility. Even within a small primary care practice, there are difficulties in controlling all patients and defining the exact number of people suffering from different diseases. Thus, one of the effective ways to find out how many patients have a certain illness is the application of electronic health records (EHR). It was introduced last year, but still, all charts are manual.
This fact makes keeping patient records and managing data and information more complicated. It is particularly important for patients with type 1 and 2 diabetes. It is important to know the number of individuals with diabetes to provide them with the necessary care. In case of diabetes is unmanaged, it can cause serious complications, including “heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations and premature death” (National Committee on Quality Assurance, n.d., para. 3).
However, the constant control and proper management of the disease can reduce possible risks and avoid complications. The research by Han et al. (2014) proved that “after adjustment for patient and practice characteristics, use of diabetes registries for patient reminders and quality improvement was associated with improved care and lower acute care utilization” (p. 8). Another intervention contributing to control and patient care efficiency in diabetes is the Healthcare Effectiveness Data and Information Set (HEDIS).
Application of HEDIS Comprehensive Diabetes Care
HEDIS provides certain components that should be measured and recorded among patients with type 1 and 2 diabetes to do this project and care for diabetes effective. First of all, a patient should be an adult, 18–75 years old, with type 1 or type 2 diabetes, and have each of the following features.
- Hemoglobin A1c (HbA1c) testing.
- HbA1c poor control (>9.0%).
- HbA1c control (<8.0%).
- HbA1c control (<7.0%) for a selected population.
- An eye exam (retinal) was performed.
- Medical attention for nephropathy.
- Blood pressure control (<140/90 mm Hg) (National Committee on Quality Assurance, n.d., para. 2).
All these tests and examinations should be taken and documented by specialists and then included in EHR to make them available to any healthcare professional working with the patient. This intervention would allow us to define the number of patients who have all the mentioned components of HEDIS.
On the whole, the goal of the HEDIS program is to provide quality care. It is an integrated tool that helps to manage the whole industry of healthcare and thus improve patient outcomes. Applied in the majority of health plans throughout the country, HEDIS is a tool that can contribute to measuring the performance of healthcare service. Thus, its application should be obligatory for all healthcare providers to ensure the quality of patient care.
Han, W., Heider, A., Singh, G., Sharman, R., Maloney, N., & Singh, R. (2014). Impact of electronic diabetes registry use on care and outcomes in primary care. In Twentieth Americas Conference on Information Systems (pp. 2662-2671). Savannah, USA: Curran Associates.
National Committee on Quality Assurance. (n.d.). Comprehensive diabetes care. Web.
Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.
Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Mosby.