To measure the performance of diabetes management, the American Medical Association (AMA), the National Committee for Quality Assurance (NCQA), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have worked together to develop a Consensus Statement that focuses on physician-level and plan-level performance measurement for outpatient care. This collaborative effort is a model that identifies measures at the health plan, provider organization, and physician levels.

Based on the current knowledge for clinical recommendations and treatment goals for adult diabetes management, the guidelines from organizations such as the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) were used to develop the measures. In addition, the work conducted under the Diabetes Quality Improvement Project, which is sponsored by the ADA, the Foundation for Accountability (FACCT), the Center for Medicare and Medicaid Services (CMS, formerly HCFA), NCQA, the American Academy of Family Physicians (AAFP), the American College of Physicians-American College of Internal Medicine (ACP-ASIM), and the Veterans Administration was also referenced to finalize the Consensus Statement.


Aspect of Care Consensus Measures HEDIS Measure *
A1C Management A1C tested at least annually Comprehensive Diabetes Care: One A1C test during measurement year.
A1C poorly controlled (>9.5%) Comprehensive Diabetes Care: A1C poorly controlled (>9.5%) measured by evaluating the most recent level taken during measurement year. If no test is documented, the level is considered to be >9.5%.
Lipid Management Lipid testing at least annually Comprehensive Diabetes Care: LDL-C Screening: Test performed in measurement year or the year before.
Lipid levels <130 mg/dL controlled** Comprehensive Diabetes Care: LDL-C controlled: Most recent LDL-C level taken in the measurement year or the year before is <130 mg/dL..
Urine Protein Testing Testing for microalbuminuria at least annually (every two years for low-risk patients) Comprehensive Diabetes Care: Monitoring for nephropathy: Test for microalbuminuria in the measurement year. This test can be performed in the prior year for low-risk patients (e.g., those not prescribed insulin in the measurement year; A1C test is <8.0, or negative test result was found in the prior year).
Eye Examination Screening examinations for diabetic retinopathy at least annually (every two years for low-risk patients) Comprehensive Diabetes Care. Eye exam performed in the measurement year. This test can be performed in the year prior for low-risk patients (e.g., those not prescribed insulin in the measurement year; A1C test is <8.0, or eye care exam in measurement year showed no evidence of retinopathy).
Influenza Immunization Influenza immunization status, eligible patients Flu Shots for Older Adults: Vaccination during the measurement year for Medicare members who reported having the immunization through a patient survey.
Foot Examination Foot exam at least annually N/A
Blood Pressure Management Blood pressure read at office visit N/A
Control of blood pressure level (< 140/90mm/Hg) N/A
Office visits Two or more office visits per year N/A
Pneumonia vaccination (in development)
Activities of daily living (NA)
Patient satisfaction (access)
Advising Smokers to Quit: Current smokers or recent quitters who have been advised to quit smoking by the practitioner during the measurement year.

* References for HEDIS are taken from the HEDIS 2000 Technical Specifications. The age ranges for measures are as follows: For comprehensive diabetes care, the eligible population is those persons aged 18-75 and diagnosed with Type 1 or Type 2 diabetes; for flu shots for older adults, the population measured is 65 years and older; for controlled high blood pressure, the age group is those individuals between the ages of 46 and 85 with a confirmed diagnosis of hypertension; for smokers or recent quitters aged 18 years and older as of December 31 of the measurement year.

** ADA recently adopted cholesterol guidelines released by the National Cholesterol Education Program (NCEP) and recommends the following: The primary goal of therapy for adult patients with diabetes is to lower LDL cholesterol to < 100 mg/dl. Revision to Consensus Measure is under consideration.

The U.S. Department of Health and Human Services' National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.