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HEDIS measures found accurate, but misclassification can occur
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Healthcare Effectiveness Data and Information Set measures are accurate and useful to assess delivery of immunizations, but users of this data should be aware that certain circumstances can result in misclassification.
David G. Bundy, MD, MPH, of the divisions of quality and safety, and general pediatrics and adolescent medicine, Johns Hopkins University School of Medicine, and colleagues reviewed the accuracy and usefulness of Healthcare Effectiveness Data and Information Set (HEDIS) measures that track childhood immunization rates.
Bundy and colleagues studied a sample of 12,096 children aged 24 to 35 months from the 2009 National Immunization Survey and looked at six types of immunizations: hepatitis B, diphtheria-tetanus-acellular pertussis, pneumococcal conjugate (PCV; Prevnar, Pfizer), inactivated poliovirus, measles-mumps-rubella (M-M-R II, Merck) and varicella-zoster virus (Varivax, Merck).
HEDIS measures were described by the researchers as “quite accurate,” with more than 90% accuracy. However, researchers said hepatitis B and PCV had the least accurate measure, and children who had missed immunizations tended to be misclassified. “The most important predictor of HEDIS measure accuracy and usefulness was the CDC-recommended number of immunizations due at age 2 years; children with zero or all immunizations due were the most likely to be correctly classified.”
Despite some misclassification, the overall HEDIS composite result misclassified only one in nine children, which the researchers concluded was low enough to deem HEDIS useful.
“Given the profound health and societal benefits associated with the reliable delivery of childhood immunizations, efforts to measure and improve immunization delivery processes are essential,” the researchers wrote. “HEDIS immunization measures have served for years as an important means of comparing immunization delivery across patient populations, providers, and health plans, and will continue to do so.”
Disclosure: Dr. Bundy reports no relevant financial disclosures. The study was funded by the National Institutes of Health.
Perspective
Back to TopRichard Lander, MD
This report is well written and well discussed. The authors certainly went over the many variables that are involved with HEDIS reporting.
For me, the most important statement was “HEDIS measures were not designed as a perfect mirror to the CDC recommendations upon which they are based.” I looked at that statement and thought about their discussions regarding pay-for-performance (P4P) and how the payors, managed care organizations use HEDIS reporting for financial incentives to the doctors.
In these hard financial times with families moving around the country to keep their jobs or to find a job, with $40 co-pays and with high-deductable insurance plans causing many people to put their health care needs on hold, vaccines are not always on their agenda. We pediatricians, who realize the importance of vaccines in preventing diseases, lose the financial incentives offered by the insurers for no fault of ours. I understand the timeline standards set by the CDC to maximize the effectiveness of the vaccines but to tie financial incentives to these same timelines does not seem fair to me.
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