Investigating Gender
Differences in HEDIS
Measures Related to
Heart Disease
Ann F. Chou, PhD, MPH
Carol S. Weisman, PhD
Rosaly Correa-de-Araujo, MD, PhD
Sarah H. Scholle, DrPH, MPH
Background
• Substantial literature documents
gender disparities in guidelineindicated preventive and treatment
services related to cardiovascular
disease (CVD).
• Women may need more aggressive
risk factor management than men due
to differences in risk factors and
symptom presentation.
CVD in Managed Care Population
• A significant portion of the US population
receives care through managed care
organizations, where the quality of care
may be more uniform.
• Few studies that examined gender
disparities in CVD-related care among
managed care enrollees.
Study Objectives
• To assess the reportability of
CVD measures by gender (under
existing specifications)
• To determine whether gender
disparities in performance were
evident within health plans
CVD-related HEDIS Measures
• Beta blocker treatment post acute myocardial
infarction (AMI)
• Persistence of beta blocker treatment post AMI
• Controlling high blood pressure
• Comprehensive diabetes care:
– Cholesterol screening
– LDL control <100 mg/dL
• Cholesterol management after acute
cardiovascular event:
– Cholesterol screening
– LDL control <100 mg/dL
NCQA Sample Recruitment
• 289 Plans, varied by measure, that
submit 2005 HEDIS performance data
to NCQA were invited to participate in
feasibility test.
• The final sample included 46
commercial health Plans,
representing a national sample.
Participating Plan Characteristics
Plans in Study
All Others Reporting HEDIS
• Profit status
• Profit status
– For profit: 33 (73.3%)
– Not for profit: 12 (26.7%)
• Model type
– Group: 2 (4.4%)
– IPA/Network: 25 (54.4%)
– Mixed Model: 19 (41.3%)
• Size*
– <95,000 members: 16 (34.8%)
– 95,000+: 30 (65.2%)
– For profit: 169 (72.2%)
– Not for profit: 65 (27.8%)
• Model type
– Group: 10 (4.1%)
– IPA/Network: 114 (46.9%)
– Mixed Model: 119 (49.0%)
• Size
– <95,000 members: 141
(58.0%)
– 95,000+: 102 (42.0%)
Comparing Performance of Plans in Study
v. All Other HEDIS-reporting Plans
Measures
Average Performance
Plans in
Study (%)
All other
HEDIS
Plans (%)
t-test
Beta Blocker treatment
97.4
95.8
-2.08*
Persistence of beta blocker
69.0
67.0
-0.95
High blood pressure control
69.2
66.3
-2.42*
Cholesterol Screening-diabetes
92.4
90.7
-2.38*
LDL Control <100 – diabetes
41.9
39.9
-1.78
Cholesterol Screening-CVD
event
83.7
81.3
-2.53*
LDL Control <100 – CVD event
53.7
50.4
-2.02*
Methods
• Descriptive statistics
• Calculation of disparities score (malefemale difference)
• T- and chi-square tests to determine
significance of the gender difference
Sample and Reportability of Gender
Stratified Data
Measures
Commercial Plans
Overall
Male
Female
Beta Blocker treatment
46
19
17
Persistence of beta blocker
46
13
13
High blood pressure control
46
45
45
Cholesterol Screening-diabetes
46
46
46
LDL Control <100 – diabetes
46
46
46
Cholesterol Screening-CVD
event
46
36
36
LDL Control <100 – CVD event
46
35
35
Performance Rates by Gender
Performance Rates in %
Measures
t-Test
N
overall
Male
Female
t
p-value
Beta Blocker
treatment
44
97.4
95.4
93.1
1.79
0.09
Persistence of beta
blocker
37
69.0
70.8
70.1
0.33
0.75
High blood pressure
control
46
69.2
69.0
69.2
-0.28
0.78
Cholesterol
Screening-diabetes
46
92.4
92.9
91.7
2.70
0.75
LDL Control <100 –
diabetes
46
41.9
44.4
38.8
8.14
<.0001
Cholesterol
Screening-CVD event
44
83.7
84.2
81.6
2.82
0.008
LDL Control <100 –
CVD event
44
53.7
56.4
47.1
6.38
<.0001
Distribution of Disparity Scores
N
Mean
Std.
Deviation
Minimum
Maximum
Beta Blocker treatment
17
1.8
4.2
-3.3
10.0
Persistence of beta
blocker
13
0.7
8.3
-11.9
12.6
High blood pressure
control
45
-0.2
4.8
-10.9
8.4
Cholesterol Screeningdiabetes
46
1.1
2.8
-5.9
8.2
LDL Control <100 –
diabetes
46
5.6
4.6
-3.9
16.9
Cholesterol ScreeningCVD event
36
2.5
5.4
-8.6
16.4
LDL Control <100 – CVD
event
35
9.3
8.4
-3.4
31.8
Magnitude of Gender Disparities
Measures
N
Plan Disparity ±5%: N (%)
Favor Women
Favor Men
Beta Blocker treatment
17
0 (0)
4 (23.5)
Persistence of beta blocker
13
2 (15.4)
4 (30.8)
High blood pressure control
45
9 (20.0)
8 (17.8)
Cholesterol Screening-diabetes
46
1 (2.2)
2 (4.3)
LDL Control <100 – diabetes
46
0 (0)
25 (54.3)
Cholesterol Screening-CVD
event
36
3 (8.3)
9 (25.0)
LDL Control <100 – CVD event
35
0 (0)
22 (62.9)
Conclusion
• Reporting of CVD measures based on
gender is feasible for most measures.
• Differences in plan performance by
gender were noted for 3 of the 7 CVD
measures.
Discussion
• The CVD measures demonstrated a
large range in disparity score among
plans. LDL control for those with a
history of CVD ranged from 3.4 in
favor of women to 31.8 in favor of men
in commercial plans.
• Denominator size limited adequate
assessment for several CVD
measures.
Implications
• Consumers/patients
• Providers
• Health plans
Acknowledgements
• The Agency for Healthcare Research and
Quality and the American Heart
Association provided funding support for
this research.
• NCQA staff provided data management
and administrative support.