Evaluation of Performance Measurement/Outcomes

As part of their commitment to the TOD initiative, each member health plan agreed to participate in ongoing performance evaluation through the annual submission of data on diabetes-related performance measures. TOD staff continue to work with the Evaluation Workgroup, Advisory Group, Senior Staff Planning Committee, and outside consultants to determine how best to gather these data without imposing an undue burden on health plans. Because the goals of the initiative are tied to complex long-term health outcomes, i.e., the reduction of cardiovascular complications, amputations, onset of end stage renal disease, and vision loss, collecting data that capture the impact of the initiative represents a significant challenge.

To best accomplish this, a staged approach to data collection is most likely, especially given that health plan access to information varies greatly. The staged evaluation approach will allow all participating health plans the opportunity to submit data at the level of their current information systems, while promoting a growth process in data collection and analysis over the duration of the initiative. The goal is to encourage all health plans to provide Level One data initially while working towards submission of Level Two and Three data by the close of the initiative.

• Level One Data Elements – These data elements will be required of all participating health plans. They are based on administrative data, which should be available to and accessible by all health plans/provider groups. Likely data elements include:
• Whether a retinal eye examination was conducted
• Whether a hemoglobin A1c (HbA1c) test was performed
• Whether a lipid test/profile was performed
• Level Two Data Elements – These data elements will require a combination of administrative and medical-record data (largely because of the presence of laboratory values). They include the measures in Level One, as well as additional measures drawn from those developed as a part of the Diabetes Quality Improvement Project (DQIP). The DQIP measures were jointly developed by the American Diabetes Association (ADA), the Foundation for Accountability (FACCT), the Health Care Financing Administration (HCFA), the National Committee for Quality Assurance (NCQA), the American Academy of Physicians (AAP), the American College of Physicians (ACP), and the Veterans Administration (VA). The measures include:
• The three Level One measures:
• Whether a retinal eye examination was conducted
• Whether a hemoglobin A1c (HbA1c) test was performed
• Whether a lipid test/profile was performed
• Four additional measures, the percentage of a population with:
  • poor HbA1c control;
  • lipids controlled;
  • monitoring for diabetic nephropathy (kidney disease);
  • and blood pressure controlled.

A DQIP abstraction toolkit, designed to assist health plans in data collection, is available from HCFA. The toolkit has been developed to help health plans and providers reliably collect and report the DQIP measures. It contains a video, user’s guide, training records, and data abstraction software. The toolkit can be ordered from HCFA or downloaded by visiting HCFA’s DQIP website at www.hcfa.gov/quality/3l.htm.

Taking on Diabetes
601 Pennsylvania Avenue, NW
South Building, Suite 500
Washington, DC 20002
(202) 778-3281
takingondiabetes@ahip.org