NCQA EXPERT PANEL TO REVIEW FIRST-YEAR DIABETES MEASURE
WASHINGTON—The National Committee for Quality Assurance (NCQA) will convene an expert panel to examine recent evidence with respect to intensive hemoglobin A1c (HbA1c) control among patients with diabetes. The group will consider a performance measure added to the Healthcare Effectiveness Data and Information Set (HEDIS®) in 2007 that assesses the percentage of patients with diabetes whose HbA1c levels are controlled to less than 7 percent.
Recent data from a clinical trial sponsored by the National Heart, Lung and Blood Institute (NHLBI) suggested increased mortality among high-risk patients undergoing aggressive treatment for HbA1c control—the target for this group was less than 6 percent—compared with those on a more conventional regimen. The NHLBI halted the intensive-treatment arm of the ACCORD study in early February. The following week, leaders of another study of intensive diabetes treatment, the ADVANCE trial, released early findings that indicated no excess mortality among a group receiving intensive HbA1c treatment.
“Solid evidence is the foundation of any HEDIS measure,” said NCQA President Margaret E. O’Kane, “The apparent contradiction in these findings demand a thorough review of the evidence. It is incumbent upon us to chart a prudent course of action for this measure. This process will yield the best decision on a complex and important matter.”
Effective HbA1c control is a long-established centerpiece of diabetes management. Multiple studies have shown that poor HbA1c control increases patients’ risk of complications from diabetes including amputations and eye, kidney and nerve disease. Currently, two HEDIS measures assess how well HbA1c levels are controlled among patients with diabetes. One measure assesses the percentage of diabetics whose HbA1c levels are above 9 percent, a widely accepted indicator of poor control. The HEDIS measure under review by the expert panel assesses the percentage of patients whose HbA1c was managed to below 7 percent. That measure was first collected by health plans in 2007.
The panel of diabetes experts representing a diverse set of stakeholders will systematically review the available evidence, including data from the ACCORD and ADVANCE trials as they are made available. NCQA will prepare a summary of the panel’s findings, a series of options for future treatment of the measure of strict HbA1c control and recommendations for action. The panel’s findings and recommendations will then be considered by NCQA’s Committee on Performance Measurement (CPM), the standing body that takes formal action on all HEDIS measures. The CPM’s decision will then be reviewed and voted upon by NCQA’s Board of Directors.
“Anyone with diabetes should speak with their doctor before changing their course of care,” O’Kane cautioned. “The ACCORD and ADVANCE studies covered specific populations. Nobody should take these results as a signal to stop worrying about blood sugar control.”
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. For more information, visit http://www.ncqa.org/.
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