New diabetes HEDIS blood pressure quality measure: potential for overtreatment.
OBJECTIVE
To examine reasons for failing to meet the new Healthcare Effectiveness Data and Information Set (HEDIS) blood pressure (BP) measure for diabetes patients (BP <130/80 mm Hg), which may not accurately identify poor-quality care and could promote overtreatment through its performance incentives.


METHODS
Retrospective chart review.


METHODS
We formed 2 cohorts of diabetes patients in 9 general medicine clinics in an academic healthcare system. Cohort A (n = 124) failed the new HEDIS measure but passed the old measure (systolic blood pressure [SBP] 130-139 and diastolic blood pressure [DBP] <90 mm Hg; or SBP <140 and DBP 80-89 mm Hg). Cohort B (n = 125) failed the old measure (SBP > or = 140 and/ or DBP > or = 90). We reviewed medical records to ascertain clinician response to elevated BP.


RESULTS
Physicians documented treatment changes in only 4% and 28% of cohort A and B patients, respectively. Refractory systolic hypertension was common in those aged > or = 65 years; 60% of those in cohort B and 58% in cohort A took 3 or more antihypertensive medications and/or had a diastolic BP below 70 mm Hg.


CONCLUSIONS
We identified a substantial cohort of elderly diabetes patients with DBP <70 mm Hg who were on 3 medications at adequate doses, but who did not meet the current performance measurement criteria (140/90 or 130/80 mm Hg). We suggest that such patients be excluded from performance measures, or if included, be noted for special attention by clinicians to balance intensification with risk.
College of Pharmacy, University of Michigan, 4260 Plymouth Rd, Ann Arbor, MI 48109, USA. haemi@umich.edu
Hae Mi
HM
Choe
Steven J
SJ
Bernstein
Connie J
CJ
Standiford
Rodney A
RA
Hayward
D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies
D000959:Antihypertensive Agents