Diabetes is one of the leading causes of disability and death in the United States. It can cause blindness, nerve damage, kidney disease, and other health problems if it’s not controlled.
One in 11 Americans have diabetes — that’s more than 29 million people. And another 86 million adults in the United States are at high risk of developing type 2 diabetes.
We can help our diabetic patient population by utilizing the Healthcare Effectiveness Data and Information Set (HEDIS) performance measurements as a guideline.
1. Comprehensive Diabetes Care (CDC)-Blood Sugar Controlled/HbA1c Controlled:
The percentage of members ages 18-75 with diabetes (Type 1 and Type 2) who had an HbA1c lab test during the measurement year that showed their blood sugar is under control (<9%)
Hemoglobin A1c screening test performed during the measurement year, as identified by claim/encounter or automated laboratory data.
2. Comprehensive Diabetes Care (CDC)-Kidney Disease Monitoring/Medical Attention to Nephropathy:
Percentage of members ages 18-75 with diabetes (Type 1 and Type 2) who had medical attention for nephropathy during the measurement year.
Microalbumin, random urine w/creatine or microalbumin, 24 hour urine, w/o creatine test performed during the measurement year.
3. Comprehensive Diabetes Care (CDC)-Diabetes Care/Eye Exam:
Percent of members age 18-75 with diabetes (Type 1 and Type 2) who had a retinal or dilated eye exam by an optometrist or ophthalmologist in the measurement year or a negative retinal eye exam (no evidence of retinopathy) in the year prior to the measurement year.
Blindness is not an exclusion for a diabetic eye exam because it is difficult to distinguish between individuals who are legally blind but require a retinal exam and those who are completely blind and therefore do not require an exam.
For more information regarding other Quality Performance Measures, please click here for a copy of our CSMS-IPA Quality Performance Measures Guide.