JAMA Study Challenges Key HEDIS Diabetes Measure
MANAGED CARE March 2000. ©2000 MediMedia USA
The National Committee for Quality Assurance has used HEDIS to encourage health plans to nudge physicians into screening diabetic patients annually for retinopathy. But the message hasn't taken; only 41 percent of diabetics in any given health plan receive routine eye exams once a year, according to 1998 HEDIS data.
Now, a study in the Journal of the American Medical Association says once a year may be overdoing it. Researchers from the Veterans Affairs Health Service and the University of Michigan reported Feb. 16 that for some low-risk diabetics, "annual screening offers marginal benefit over every-other-year screening." For patients with good glycemic control, a three-year cycle is almost as beneficial and more cost-effective, they wrote.
The authors acknowledge that while diabetes is a leading cause of blindness, a 65-year-old low-risk patient would gain three days of sight when screened annually, as opposed to every third year. Screening all diabetics once a year, they said, increases unnecessary costs and patient burden.
The American Diabetes Association stands by its guideline recommending annual eye exams. ADA says its guideline is based on clinical observation, not computer modeling, as was done in the JAMA study. Further, it says, the study only examined screening's value in terms of blindness, and not partial loss of vision.