title: Eye examinations for VA patients with diabetes: standardizing performance measures.
abstract: OBJECTIVE
  To demonstrate the potential of the Health Plan Employer Data and Information Set (HEDIS) for the calculation of a performance measure for eye exams in the diabetic population using Veterans Health Administration (VA) administrative data.
  
  
  METHODS
  We calculated a 1-year HEDIS-defined patient denominator and three alternative denominators that considered coding factors in identifying a VA patient as diabetic. We calculated the HEDIS-defined numerator, along with alternative specifications that captured other types of eye exams. Finally, we supplemented national data with VA pharmacy and Medicare claims data to identify all VA diabetic patients at 14 selected VA facilities and to establish a more accurate picture of non-VA health care utilization.
  
  
  RESULTS
  The national average annual HEDIS-defined eye exam rate in the VA was 26% in fiscal 1997 compared with 39% for managed care organizations. Medicare utilization raised this by 15 percentage points at 14 northeastern VA hospitals. Over 2 years, at least two-thirds of diabetic VA patients had some type of eye exam through VA or Medicare.
  
  
  CONCLUSIONS
  A HEDIS measure of eye exams for VA patients with diabetes can be calculated using VA administrative data only. However, the question remains to what extent the denominator and numerator accurately and completely identify all diabetic patients using VA services and all appropriate eye exams. We recommend caution in interpreting the results of performance measurement across different health care sectors based on what we currently know are data system limitations.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA. djonesl@bu.edu
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: A
authors.initials: A
authors.lastname: Hendricks
authors.forename: C
authors.initials: C
authors.lastname: Comstock
authors.forename: A
authors.initials: A
authors.lastname: Rosen
authors.forename: B H
authors.initials: BH
authors.lastname: Chang
authors.forename: J
authors.initials: J
authors.lastname: Rothendler
authors.forename: C
authors.initials: C
authors.lastname: Hankin
authors.forename: M
authors.initials: M
authors.lastname: Prashker
mesh_terms: D000328:Adult; D019985:Benchmarking; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000209:etiology; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D006264:Health Benefit Plans, Employee / Q000592:standards; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D014481:United States