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New HEDIS Measures Proposed by NCQA

Kate Traynor

The National Committee for Quality Assurance (NCQA) has proposed changes to the Health Plan Employer Data and Information Set (HEDIS) for 2004 and will accept public comments on these changes through 5 p.m. Eastern Standard Time on March 21.

Among NCQA’s proposed changes to HEDIS are new performance measures on the use of antimicrobial drugs in children. One measure aims to reduce the inappropriate use of antimicrobials to treat upper-respiratory-tract infections—that is, the common cold—in infants and children between the ages of 3 months and 18 years.

A second performance measure concerns the treatment of pharyngitis in infants and children between the ages of 3 months and 16 years. Specifically, the proposed HEDIS measure requires that the child test positive for group A streptococcal pharyngitis before receipt of antimicrobial therapy.

According to NCQA, both pediatric performance measures match current clinical practice guidelines on the judicious use of antimicrobial drugs.

A third newly proposed HEDIS measure addresses postfracture management of osteoporosis in women. This measure would assess the number of women age 67 or older who were prescribed a drug to treat osteoporosis or underwent a bone scan within six months after the fracture. NCQA is soliciting comments on two proposed versions of the quality indicator—one covering women who were undergoing osteoporosis treatment before the fracture, and one excluding these women. The committee is particularly interested in comments related to hormone therapy for the prevention of osteoporosis, because the use of this treatment is declining.

Among the proposed changes to existing HEDIS measures is the removal of congestive heart failure, diabetes mellitus, asthma, and chronic obstructive pulmonary disease as contraindications to the use of beta-blocker therapy after an acute myocardial infarction. This decision is based on recent findings that patients with such conditions can benefit from beta-blocker therapy. The measure addresses whether patients 35 years or older received a prescription for a beta-blocker on discharge from the hospital after an acute myocardial infarction.

A separate HEDIS 2004 measure deals with outpatient use of beta-blockers by seniors who are discharged from a hospital with a diagnosis of heart failure. This measure calls for beta-blocker therapy to begin within 90 days after patients leave the hospital.

Once the proposed measures are adopted, NCQA expects compliance with the measures to approach 100 percent for managed care organizations whose enrollees include commercial clients or Medicare beneficiaries.

For additional information on proposed changes to HEDIS and how to submit comments, visit the NCQA Web site.