Background
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
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.
CVDCVD-related
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:
• 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.
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
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.
– Cholesterol screening
– LDL control <100 mg/dL
1
Participating Plan Characteristics
Plans in Study
All Others Reporting HEDIS
•
•
Profit status
– For profit: 33 (73.3%)
– Not for profit: 12 (26.7%)
•
•
– Group: 2 (4.4%)
– IPA/Network: 25 (54.4%)
– Mixed Model: 19 (41.3%)
•
Model type
– Group: 10 (4.1%)
– IPA/Network: 114 (46.9%)
– Mixed Model: 119 (49.0%)
Size*
•
– <95,000 members: 16 (34.8%)
– 95,000+: 30 (65.2%)
Average Performance
Measures
Plans in
Study (%)
Profit status
– For profit: 169 (72.2%)
– Not for profit: 65 (27.8%)
Model type
Comparing Performance of Plans in Study
v. All Other HEDISHEDIS-reporting
HEDIS-reporting Plans
t-test
-2.08*
Beta Blocker treatment
97.4
95.8
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*
Size
– <95,000 members: 141
(58.0%)
– 95,000+: 102 (42.0%)
Sample and Reportability of Gender
Stratified Data
Methods
Measures
• Descriptive statistics
• Calculation of disparities score (malefemale difference)
• T- and chi-square tests to determine
significance of the gender difference
Performance Rates by Gender
Performance Rates in %
Measures
All other
HEDIS
Plans (%)
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
Distribution of Disparity Scores
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
N
Mean
Beta Blocker treatment
17
1.8
Std.
Minimum
Deviation
4.2
-3.3
Maximum
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
2
Magnitude of Gender Disparities
Measures
N
Conclusion
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)
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.
• 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.
Implications
• Consumers/patients
• Providers
• Health plans
• Denominator size limited adequate
assessment for several CVD
measures.
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.
3