One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the components of HEDIS comprehensive diabetes care; then consider the following scenario. You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes.

The Healthcare Effectiveness Data and Information Set Comprehensive care measures for diabetic care include:

1. HbA1c control: The HbA1c measure measures the proportion of diabetic patients who are able to maintain their blood glucose levels in the last three months. It is important to keep HbA1c levels below 8%.
2. Measures include: Eye exam, which is the number of diabetic patients who had an eye examination in the last year for the purpose of screening diabetic retinopathy.
3. The percentage of diabetic patients who received treatment for kidney disease (nephropathy) is measured.
4. The measure measures the percent of diabetic patients who are able to control their blood pressure. A target is less than 140/90mmHg.
5. The Cholesterol Control Measure: It measures the percent of diabetic patients who are able to control their LDL levels. This target is less than 100mg/dL.
6. Comprehensive Diabetes Care: The measure measures the proportion of diabetic patients who received the entire package of diabetes care.

Considering the case presented, a primary care clinic with 2 MDs and 2 nurses as well as a billing staff can utilize HEDIS measures to enhance the care of their diabetic patients. EHRs can be used to facilitate HEDIS implementation and track performance.

For a practice to get started, it could start with HEDIS by focusing only on a few measures that need improvement. The practice could improve the proportion of HbA1c-controlled patients, as an example. The practice can help patients learn about how important it is to monitor their blood sugar regularly, and follow their treatment plan. It could set up an automated reminder for patients to return for their regular HbA1c tests.

The practice may also want to consider creating a registry for diabetes patients in order to monitor their progress and make sure they receive the appropriate care. The registry could include data on patients’ HbA1c levels, blood pressure, cholesterol levels, and other relevant measures.

To ensure that their efforts to improve quality are successful, the medical practice can create a team of doctors, nurses and assistants. This team would meet to analyze data and create strategies to better care for diabetic patients. Staff could be educated and trained by the team to help them provide quality care for their diabetic patients.