Healthcare Effectiveness

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 Healthcare Effectiveness 


One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the components of HEDIS comprehensive diabetes care; then consider the following scenario.

You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes. 

Take on the role of the staff nurse in the scenario and post an explanation of how you would go about finding out how many diabetics are in your practice and how many meet all components of HEDIS comprehensive diabetes care.


· Spath, P. (2018). 
Introduction to healthcare quality management (3rd ed.). Health Administration Press.

· Chapter 3, “Measuring Performance” (pp. 35-78)

· Chapter 4, “Evaluating Performance” (pp. 79-118)


· Yoder-Wise, P. S. (2019).
 Leading and managing in nursing (7th ed.). Mosby.

· Chapter 23, “Managing Quality and Risk” (pp. 406-427)

· Chapter 24, “Translating Research Into Practice” (pp. 427-449)


· Perla, R. J., Provost, L. P., & Murray, S. K. (2011). 

The run chart: A simple analytical tool for learning from variation in healthcare processesLinks to an external site.

BMJ Quality and Safety, 20(1), 46–51.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level.

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use 
evidenceLinks to an external site. from the readings and include 

in-text citationsLinks to an external site.
. Utilize 

essay-levelLinks to an external site.
 writing practice and skills, including the use of 

transitional materialLinks to an external site.

organizational framesLinks to an external site.
. Avoid quotes; 
paraphraseLinks to an external site. to incorporate evidence into your own writing. A 

reference listLinks to an external site.
 is required. Use the most 

current evidenceLinks to an external site.
 (usually ≤ 5 years old).


Read two or more of your colleagues’ postings from the Discussion question.

Octavia Henry

As a staff nurse in a private primary care practice, my approach to improving the quality of diabetes care would be multi-faceted. First, I would conduct a chart review to determine how many patients in our practice have diabetes, and assess our adherence to the HEDIS comprehensive diabetes care measures. This involves reviewing documentation related to diabetes diagnosis and management, including lab results, medications, and progress notes.

After identifying our diabetic patient population and our current level of compliance with guidelines, the next step would be to develop a system for regular patient follow-up and monitoring. This could involve scheduling regular appointments and check-ins for diabetic patients, sending reminders for recommended screenings and evaluations, and providing education and support for managing diabetes outside the clinical setting.

One potential strategy for improving patient outcomes is to implement group visits for diabetic patients. Group visits have been shown to improve glycemic control, possibly reduce healthcare costs, and increase patient satisfaction (
Effect of Group Medical Appointments on Glycemic Control of Patients with Type 2 Diabetes, n.d.). During these visits, diabetic patients can receive education and support from both healthcare providers and fellow patients. They can also participate in group activities such as cooking demonstrations or exercise classes, which can help promote healthy behaviors and social support.

In addition to improving the quality of care within our practice, it would be important to explore opportunities for collaboration with other healthcare providers and community organizations in the management of diabetes. We could partner with local hospitals and clinics to refer patients for specialized care, or work with community health organizations to provide education and resources to diabetic patients and their families.

Finally, utilizing technology such as electronic health records (EHRs) and telehealth can also help improve the quality of diabetes care. EHRs can facilitate communication between healthcare providers and increase the accuracy of documentation, while telehealth can allow diabetic patients to receive care and support remotely, especially in cases where travel to the clinic may be difficult or expensive.

In summary, improving the quality of diabetes care in a primary care practice requires a comprehensive approach involving regular patient follow-up and monitoring, group visits for diabetic patients, collaboration with other healthcare providers and community organizations, and the use of technology such as EHRs and telehealth. By implementing these strategies, we can improve outcomes for diabetic patients and enhance their overall healthcare experience.


Effect of group medical appointments on glycemic control of patients with type 2 diabetes. (n.d.). American Diabetes Association. to an external site.

Rebekah Parke

     The Healthcare Effectiveness Data and Information Set (HEDIS) is a nationally used way of measuring if patients are receiving appropriate care for their specific diagnoses. The HEDIS is used to make comparisons between healthcare plans and among 90% of health plans including PPOs, Medicare and Medicaid (Healthcare Effectiveness Data and Information Set [HEDIS] – Healthy People 2030, n.d.). By using the HEDIS measure, insurance providers can audit the participants’ care to assure that they are receiving the standard treatments.

     In the given example, as a staff nurse in this clinic, I would first start by making a spread sheet to list all the diabetic patients. I understand this would be quite the task since the charts are manual. The paper charts would have to be sorted through and separated for those with diabetic patients. Then the patient information would be entered into the spread sheet.  While I was looking through the charts to sort out the diabetic patients, I would look for records of diabetic care education, blood pressure records, hemoglobin A1c levels, if they have a history of neuropathy, as well as when their last visit at the office was for diabetes management (Kutz et al., 2018).

     Once all the charts were sorted through, I would be able to sort the information with the spread sheet. With technology there are thankfully many ways to sort and organize this information, while keeping it together with the patient, so that trends could be found in what data may be consistently missing. Other trends could be made of how many patients need certain education or screenings. In order to increase HEDIS compliance these patients could then be asked to return for group education or whatever category they may be missing. By using a spread sheet, the information would then be saved and could be accessed and added to at any time, and would be accessible by all of the providers, without having to sort through piles of paper charts.


Healthcare Effectiveness Data and Information Set (HEDIS) – Healthy People 2030. (n.d.). 
Healthcare Effectiveness Data and Information Set (HEDIS) to an external site.

Kutz, T. L., Roszhart, J. M., Hale, M., Dolan, V., Suchomski, G., & Jaeger, C. (2018). Improving comprehensive care for patients with diabetes. 
BMJ Open Quality
7(4). to an external site.

Frances Pittman

I currently work on a surgical unit with a major hospital system in the United States. There are several ways you can gather information about the number of diabetics in your practice and determine how many meet all components of HEDIS (Healthcare Effectiveness Data and Information Set) comprehensive diabetes care. One approach is to utilize electronic health records (EHRs) to identify patients with diabetes and track their progress. According to the American Medical Informatics Association (2019), EHRs provide a wealth of data that can be used to assess patient populations and measure quality of care. By conducting a search within your EHR system using specific diagnostic codes or keywords related to diabetes, you can generate a list of patients with diabetes in my practice. 

Another way I can gather data for diabetic patients on my unit is to collaborate with the quality improvement department or diabetic educator can provide valuable insights into the number of diabetics in your practice and their adherence to HEDIS measures. Quality improvement programs often involve regular data collection and analysis to monitor and improve patient care. According to the Agency for Healthcare Research and Quality (2020), these initiatives promote evidence-based practices and facilitate the achievement of quality benchmarks.  

Previously I was employed as a nurse in a small private primary care practice without an electronic health record (EHR) system, there are still several strategies you can employ to gather information about diabetic patients and assess their adherence to quality measures. Although manual charting has been the historical practice, transitioning to a more organized and structured approach can help you meet the physicians’ inquiries about quality incentives, specifically concerning patients with diabetes. 

A manual registry specifically for patients with diabetes. According to Solberg et al. (2017), manual registries can effectively track patient populations and measure quality indicators. Create a list of all patients diagnosed with diabetes in the practice and maintain it in a centralized location. Regularly update the registry to capture new cases and changes in patients’ conditions. 

Perform regular chart audits to assess the level of care provided to diabetic patients. This process involves reviewing patient charts for documentation of key diabetes care components, such as HbA1c levels, blood pressure measurements, lipid profiles, and foot examinations. By conducting chart audits, you can identify gaps in documentation and measure adherence to quality measures. The American Diabetes Association (ADA, 2019) emphasizes the importance of documentation in providing evidence-based diabetes care. 


American Diabetes Association. (2019). Standards of Medical Care in Diabetes—2019. Diabetes Care, 42(Supplement 1), S1-S193. 

American Medical Informatics Association. (2019). Electronic Health Records. Retrieved from to an external site.

Solberg, L. I., Crain, A. L., Sperl-Hillen, J. M., Hroscikoski, M. C., Engebretson, K. I., & O’Connor, P. J. (2017). Care quality and implementation of the chronic care model: A quantitative study. Annals of Family Medicine, 15(6), 537-544. 

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