Evaluating Medication Use for Continuous Quality Improvement in Diabetes Care

Copyright© 2002, Academy of Managed Care Pharmacy. All rights reserved. Author ontinuous quality improvement (CQI) is the structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide services that meet or exceed expectations. It is integral to the long-term success of managed care organizations (MCOs). Many purchasers of health care, along with accrediting bodies, have encouraged the adoption of the CQI philosophy and its tools. The hope is that CQI will lead to more efficient care as well as better health for members enrolled in health plans. The value of CQI is generally accepted, and consistent with the philosophy of CQI, the methods for measuring quality are undergoing constant evolution. The most common method for evaluating the quality of MCOs is the Health Plan Employer Data and Information Set (HEDIS) from the National Committee for Quality Assurance (NCQA). HEDIS includes performance indicators related to health promotion and the effectiveness of care for selected diseases. These performance indicators offer insight to the quality of care provided by MCOs. The number of performance indicators within HEDIS has expanded over the past several years, and the technical specifications for the indicators have been refined. Reported results and trends in the performance indicators over the past several years suggest that NCQA has been successful in stimulating quality improvement in MCOs Nonetheless, HEDIS does have limitations. Kerr and colleagues have pointed out several pitfalls in the use of HEDIS for quality improvement. These pitfalls include the lack of a strong link between many process-oriented measures and outcomes, intermediate outcomes-oriented measures that are not linked to actionable processes, measures that do not target those at highest-risk, the lack of severity adjustment for outcomes measures, and the inability of the measurement system to allow for patient exceptions. These pitfalls in the measurement system limit the utility of HEDIS for quality improvement efforts. Ideally, the current indicators in HEDIS would be supplemented by additional measures of quality that help to pinpoint specific health care processes that need improvement. Evaluating Medication Use for Continuous Quality Improvement in Diabetes Care