1. 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

2. BackgroundBackground Substantial literature documents gender disparities in guideline- indicated 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.

3. 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.

4. 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

5. 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

6. 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.

7. Participating Plan Characteristics Plans in Study 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%) All Others Reporting HEDIS Profit status –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%)

8. 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 97.495.8-2.08* Persistence of beta blocker 69.067.0-0.95 High blood pressure control 69.266.3-2.42* Cholesterol Screening-diabetes 92.490.7-2.38* LDL Control <100 – diabetes 41.939.9-1.78 Cholesterol Screening-CVD event 83.781.3-2.53* LDL Control <100 – CVD event 53.750.4-2.02*

9. Descriptive statistics Calculation of disparities score (male- female difference) T- and chi-square tests to determine significance of the gender difference MethodsMethods

10. Sample and Reportability of Gender Stratified Data MeasuresCommercial Plans OverallMaleFemale Beta Blocker treatment 461917 Persistence of beta blocker 4613 High blood pressure control 4645 Cholesterol Screening-diabetes 46 LDL Control <100 – diabetes 46 Cholesterol Screening-CVD event 4636 LDL Control <100 – CVD event 4635

11. Performance Rates by Gender Measures Performance Rates in %t-Test NoverallMaleFemaletp-value Beta Blocker treatment 4497.495.493.11.790.09 Persistence of beta blocker 3769.070.870.10.330.75 High blood pressure control 4669.269.069.2-0.280.78 Cholesterol Screening-diabetes 4692.492.991.72.700.75 LDL Control <100 – diabetes 4641.944.438.88.14<.0001 Cholesterol Screening-CVD event 4483.784.281.62.820.008 LDL Control <100 – CVD event 4453.756.447.16.38<.0001

12. Distribution of Disparity Scores NMeanStd. Deviation MinimumMaximum Beta Blocker treatment171.84.2-3.310.0 Persistence of beta blocker 130.78.3-11.912.6 High blood pressure control 45-0.24.8-10.98.4 Cholesterol Screening- diabetes 461.12.8-5.98.2 LDL Control <100 – diabetes 465.64.6-3.916.9 Cholesterol Screening- CVD event 362.55.4-8.616.4 LDL Control <100 – CVD event 359.38.4-3.431.8

13. Magnitude of Gender Disparities Measures N Plan Disparity ±5%: N (%) Favor WomenFavor Men Beta Blocker treatment170 (0)4 (23.5) Persistence of beta blocker132 (15.4)4 (30.8) High blood pressure control459 (20.0)8 (17.8) Cholesterol Screening-diabetes461 (2.2)2 (4.3) LDL Control <100 – diabetes460 (0)25 (54.3) Cholesterol Screening-CVD event 363 (8.3)9 (25.0) LDL Control <100 – CVD event350 (0)22 (62.9)

14. ConclusionConclusion 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.

15. DiscussionDiscussion 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.

16. ImplicationsImplications Consumers/patients Providers Health plans

17. AcknowledgementsAcknowledgements 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.