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HEALTHCARE

EFFECTIVENESS DATA
AND INFORMATION SET
Authors: Brittany Koepke, Omoyemi Omogunwa, Angelina Schauseil

WHAT IS A HEALTHCARE EFFECTIVENESS


DATA AND INFORMATION SET?
HEDIS is sponsored by the National Committee for Quality Assurance
(NCQA). NCQA states that HEDIS is a measuring performance tool as
stated on their website:
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by
more than 90 Percent of Americas health plans to measure performance on
important dimensions of care and service. Altogether, HEDIS consists of 81
measures across 5 domains of care. Because so many plans collect HEDIS data,
and because the measures are so specifically defined, HEDIS makes it possible to
compare the performance of health plans on an apples-to-apples basis.

WHAT ARE THE USES OF HEDIS?

ALLOW CONSUMERS TO HAVE A PLACE TO COMPARE HEALTH CARE PLANS


ALLOW ACCESS TO PROVIDERS OF NEW GUIDELINES FOR PATIENT CARE
ALLOW CONSUMERS TO TRACK YEARLY EFFECTIVENESS OF PLANS, BASED ON FIVE
DOMAINS OF CARE

THE FIVE DOMAINS OF CARE ARE:

EFFECTIVENESS OF CARE
ACCESS/AVAILABILITY OF CARE
EXPERIENCE OF CARE
UTILIZATION AND RELATIVE RESOURCE USE
HEALTH PLAN DESCRIPTIVE INFORMATION

THE IMPACT OF DATA SET IN HEALTH INFORMATIONWHAT DOES HEDIS MEAN FOR CONSUMERS?
It helps patient to take an active role in their own treatment, including
disease prevention
It ensures timely, appropriate treatment for patients
It help providers such as Physician, Nurses, HIM professionals to deliver
the most appropriate prescribed clinical impact on consumers
Data set improves sustainable approaches that continuously enhance
health care value by reducing cost and enhance better quality patient
care.

PLAN COMPARISON THROUGH HEDIS-USING THE


TOOLS

IMPACT OF HEDIS CONTINUED:


Improves Patient care
Reduces risks
Increases operational efficiencies
Supports information exchange
Enhance the national health infrastructure

REAL APPLICATION OF HEDIS


Studies can be conducted using the NCQA HEDIS to see which healthcare
measures are promoting and improving specific health conditions such as
controlling hypertension (Jaffe, Lee, Young, Sidney, & Go).

REAL APPLICATION OF HEDIS


As stated in the Journal of Womens Health, in 2009 the USPSTF (United
States Preventive Services Task Force) updated mammography
guidelines. Due to these new guidelines, the NCQA revised their
measures for mammography screening for women in their 40s and for
women in the 50-74 age range.

WORKS CITED
AHIMA. (2012). Data Quality Management Model (Updated). Journal of AHIMA , 62-67.
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049664.hcsp?dDoc
Name=bok1_049664
Esseman, MD, MBA, L., & OKane, MHS, M. (2014). Moving beyond the breast cancer screening
debate. Journal of Womens Health. Retrieved from:
http://www.ncqa.org/Newsroom/Statements/JournalofWomensHealthArticle.aspx
Jaffe MG, Lee GA, Young JD, Sidney S, Go AS (2013). Improved Blood Pressure
Control
Associated With a Large-Scale Hypertension Program.JAMA.2013;310(7):699-705.
doi:10.1001/jama.2013.108769.

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