Mount Carmel Health Partners HEDIS Tip Sheets - Page 13

HEDIS Tip Sheet Diabetes -- HbA1c Control Definition: Percentage of members ages 18-75 whose most recent HbA1c is less than 8. Service Needed: HbA1c test and result from January 1 – December 31 of the measurement year. Exclusions: One of the following: • A diagnosis of polycystic ovaries, in any setting, any time during the member’s history through December 31 of the measurement year. • A diagnosis of gestational diabetes or steroid-induced diabetes, in any setting, during the measurement year or year prior. • Hospice care in the measurement year. Chart Review Tips: • HbA1c tests are usually found in the “Laboratory” section of the chart. • Minimally, diabetic patients should have an HbA1c every year (usually physicians will order it more frequently, at least every 6 months if controlled or every 3 months if uncontrolled). • You may review correspondence for letter/progress note from endocrinologist (specialist) noting a recent HbA1c. • You may review the progress notes and history for exclusion criteria (polycystic ovaries or gestational or steroid induced diabetes). • If patient meets any of the exclusion criteria, please note for future reference. Member Outreach Tips: • Ask patients if they have had an HbA1c test this year before reminding them they are due. • If patients have not had an HbA1c this year, encourage them to schedule a visit with their PCP. • If the HbA1c is greater than 8, encourage patients to attend available educational offerings and determine any barriers to medication or dietary adherence. Supplemental Data Tips • For the patient to meet the measure, the most recent HbA1c must be less than 8. • It is helpful to have the most recent HbA1c result recorded, even if it is not less than 8. • The test date, name of the test, and test result must be documented to meet the measure. 13