Screening Rates Before and After the Introduction of the Chlamydia

HEDIS Measure in a Managed Care Organization

GR Burstein1, MA Snyder2, D Conley2, DR Newman1, CM Walsh1, G Tao1, K Irwin1

1Centers for Disease Control and Prevention2Kaiser Permanente Mid-Atlantic States

Background

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HEDIS• Health Plan Employer Data and Information Set

(HEDIS) is a a tool used to measure managed care organization (MCO) performance in key areas.

• HEDIS is supported by the National Center for Quality Assurance (NCQA) • independent non-profit organization whose mission is

to improve US health care quality

• Almost 90% of health plans measure their performance using HEDIS.

In 2000, a new HEDIS performance measure was introduced to monitor the proportion of sexually active 15-26 year-old females screened annually for chlamydia.

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Objectives

To determine changes after introduction of the HEDIS measure in a large MCO in:

1) chlamydia screening policies

2) chlamydia testing practices

3) chlamydia positivity rates

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Methods

• We reviewed electronic medical records of a large, not-for-profit MCO for

• 15-26 year-old females who were classified as sexually active according to administrative data elements specified by HEDIS

• Endocervical chlamydia tests (DNA probe; GenProbe, San Diego, CA) performed during 1998-2001

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Methods

• We used chi-square testing to compare chlamydia screening rates and positive tests for the 2 years before (1998-9) and after (2000-1) the introduction of the chlamydia HEDIS measure.

• We queried MCO departmental chiefs about practice changes implemented to meet the new HEDIS measure.

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Kaiser Permanente Mid-Atlantic States• Employer-based, not-for-profit MCO

• plan serves primary working people and their dependents • no Medicaid beneficiaries

• Serves diverse population• 21 clinics in Baltimore City, Washington DC, Maryland and Northern

Virginia suburbs

• Offers unrestricted access to OB-GYN services

• Provides confidential adolescent reproductive health care services• Explanation of Benefits not sent home which avoids breech of

confidentiality about sexual activity/sexual health services• Require adolescent permission to release confidential information

Results

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15-26 Year Old Females Who Were MCO Members, Members Classified as Sexually Active (SA) by HEDIS

Criteria and Tested for Chlamydia trachomatis, 1998-2001.

Year15-26 yo ♀ Members

n

SA 15-26 yo ♀ Members

n (%)

SA 15-26 yo ♀ Members CT Tested

n (%)

1998-9 7192737438

(52)

20571

(55)

2000-1 7156937237

(52)

26801

(72)*

*p<0.0001

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Changes in MCO Chlamydia Screening Policies by Specialty

• OB-GYN instituted policy of collecting a chlamydia test at the same time as a Pap test on 15-26 y.o. females • policy operationalized by nursing assistants automatically placing

a chlamydia collection swab next to Pap collection materials

• Other primary care specialties• Internal Medicine and Family Practice advised providers to

perform chlamydia tests with Pap smears on 15-26 y.o. females• policy merely articulated but was not operationalized within their practices

• Pediatrics offered providers adolescent heath care training

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Type of Specialty Care Received by Adolescent Female Members 15-26 Years Old Classified as Sexually Active by

HEDIS Criteria, 1998-2001

Year 1 Care OB-GYNBoth 1 Care & OB-GYN

1998-9

N=3743818% 14% 66%

2000-1

N=3723719% 13% 65%

Type of Specialty Care

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Proportion of Sexually Active 15-26 Year Old Female MCO Members Tested for Chlamydia in Specialty Departments,

1998-2001

Year 1 Care OB-GYN 1 Care OB-GYN

Both 1 Care &

OB-GYN

1998-930%

N=689857%

N=51274%

N=24731

49%

N=24731

9%

N=24731

2000-132%

N=704281%*

N=50143%*

N=24362

71%*

N=2436210%

N=24362

% of SA ♀ MCO Members CT Tested Who Were Seen in Single Specialty Care Visits Both Primary Care & OB-GYN Visits

*p<0.0001

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YearCT Tests with Paps

CT Tests with Pregnancy Test

CT Tests with Contraception Rx

1998-964%

N=28953

66%

N=16813

53%

N=22265

2000-187%*

N=28341

75%*

N=17140

74%*

N=23166

Chlamydia Tests Performed Among Female 15-26 Year Old MCO Members Who Received Paps, Pregnancy Tests,

or Filled Contraceptive Prescriptions, 1998-2001

*p<0.00001

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Proportion of Positive Chlamydia trachomatis tests Among MCO Female Members 15-26 Years Old,

1998-2001

Year

15-19 yo

n (%)

20-26 yo

n (%)

1998-9974/7623

(12.8%)

707/12948

(5.5%)

2000-1*996/8906

(11.2%)

856/17895

(4.8%)

Proportion of Positive C. trachomatis Tests

*171 more cases detected

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Conclusions

• Following HEDIS measure introduction in this MCO, % of sexually active 15-26 year-old females tested for chlamydia increased overall with little change in the % of positive tests

• Most of the increase resulted from the new OB-GYN policy of performing chlamydia screening with routine Pap tests

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Implications for Programs & Policy

• Simple systems changes and access to OB-GYN providers can improve chlamydia screening rates and detect a significant number of asymptomatic infections in an MCO

• Operationalizing policy in the health system is key to change